LAUSR

OBJECTIVE To describe a high-volume experience with biliary drainage prior to neoadjuvant therapy (NAT) for patients with operable pancreatic cancer (PC) and characterize the association between biliary adverse events (BAE) and patient outcome. BACKGROUND Patients with PC presenting with biliary obstruction require durable decompression prior to NAT. METHODS Patients with operable PC and tumor-associated biliary obstruction were examined and grouped by the presence or absence of a BAE during NAT. The incidence, timing, and management of BAE are described and outcomes, including the completion of all treatment and overall survival (OS), were compared. RESULTS Of 426 patients who received pre-treatment biliary decompression, 92 (22%) experienced at least one BAE during NAT and 56 (13%) required repeat intervention on their biliary stent. The median duration of NAT was 161 days for all patients and was not different in the group that experienced BAE. Median time from initial stent placement to BAE was 64 days. An interruption in the delivery of NAT (median 7 days) occurred in 25 (6%) of 426 patients. Among 426 patients, 290 (68%) completed all NAT including surgery: 60 (65%) of 92 patients with BAE and 230 (69%) of 334 patients without BAE (P=0.51). Among 290 patients who completed NAT and surgery, the median OS was 39 months; 26 months for the 60 patients with BAE and 43 months for the 230 patients without BAE (P=0.02). CONCLUSIONS During extended multimodal NAT for PC, 22% of patients experienced a BAE. Although BAE were not associated with a significant interruption of treatment, patients who experienced a BAE had worse OS.