Resident Medical College of Wisconsin Milwaukee, Wisconsin, United States
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Participants should be aware of the following financial/non-financial relationships:
Sam Thalji, MD: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Introduction: Neoadjuvant therapy (NeoTx) for pancreatic cancer (PC) requires durable biliary decompression. The impact of biliary complications (BC) during NeoTx are unknown.
Methods: BCs were identified in patients (pts) with operable PC of the pancreatic head/neck who had a biliary stent and received NeoTx prior to intended surgery. Association with early disease recurrence (< 1 year from surgery) and median overall survival (mOS) were assessed.
Results: Among 528 pts, 91 (17%) pts developed a BC during NeoTx at a median of 64 days (IQR 112) after initial stent placement. The cumulative incidence of BCs at 2 months (mo), 2-4 mo, >4 mo from diagnosis were 8%, 6%, and 20%. There were 113 BCs in the 91 pts: 41 (37%) stent occlusions without cholangitis, 34 (30%) stent occlusions with cholangitis, 26 (23%) cholecystitis, 1 (1%) hemobilia, 10 (9%) pancreatitis, and 1 (1%) hepatic abscess. Among 91 pts with BCs, 71 (78%) were hospitalized for a median of 4 days (IQR 4) and 25 (27%) had a delay in NeoTx (median of 7 days, IQR 8.5). Of the 528 pts, completion of NeoTx and surgery occurred in 59 (65%) of the 91 with BCs and 308 (71%) of the 437 without BCs (p=0.29). Among the 367 pts who completed NeoTx and surgery, 17 (29%) of the 59 pts with BCs had positive margins compared to 40 (13%) of the 308 pts without BCs (p=0.002). Early locoregional recurrence occurred in 47 (13%) of the 367 pts; 13 (22%) of the pts with BCs compared to 34 (11%) of 308 (p=0.02) pts without BCs. No differences were observed in rates of distant recurrence. The mOS for all 528 pts was 26 mo; 20 mo among 91 pts with a BC and 29 mo among 437 without a BC (p=0.006). For the 367 pts who completed NeoTx and surgery, mOS was 39 mo; 26 mo among 59 pts with a BC and 44 mo among 308 pts without a BC (p=0.02, Figure 1). BCs were associated with an increased risk of death (HR: 1.56; CI 1.10-2.23) in an adjusted hazards model.
Conclusions: The cumulative incidence of BCs during NeoTx was 17% and increased with duration of NeoTx but had no impact on the completion of all intended NeoTx and surgery. BCs were associated with worse outcome, possibly due to tumor-associated anatomy which predisposes to both recurrent disease and BCs.
Learning Objectives:
identify how biomarker trends during neoadjuvant therapy for pancreatic cancer may provide prognostic value.
describe the oncologic consequences of biliary complications during neoadjuvant treatment for pancreatic cancer.
describe the incidence of biliary complications at a large volume center that treats pancreatic cancer with prophylactic metal stenting during the neoadjuvant period.
