Eli P. Darnell, MD, Thomas J. Wang, MD, Melissa A. Lumish, MD, Yasmin G. Hernandez-Barco, MD, Maximillian Weniger, MD, C. Fernandez-Del Castillo, MD, Brenna W. Casey, MD, Kumar Krishnan, MD
Massachusetts General Hospital, Boston, MA
Introduction: Pancreatic adenocarcinoma continues to have a high mortality rate. Successful surgical resection (Whipple procedure) of cancer remains the only potential durable cure. In order to improve survival, many patients receive neoadjuvant chemotherapy prior to surgery, which requires biliary stenting in those patients with jaundice. Some patients will develop cholangitis from transient stent obstruction. The impact of preoperative cholangitis on the ability to get surgery is not clear. We investigate the role of cholangitis in patients with pancreatic adenocarcinoma undergoing neoadjuvant chemotherapy.
Methods: We identified all patients of Massachusetts General Hospital (MGH) from 2013 to 2018 who underwent neoadjuvant chemotherapy and received ERCP with metal biliary stenting for jaundice. Chart review was performed to identify patients who had cholangitis. We further determined the rate of successful surgery, time to surgery, and mortality rates. Statistics were performed using the student t-test or Fisher’s exact test to establish significance.
Results: In total, we identified 97 patients who establish care at MGH to pursue neoadjuvant chemotherapy in preparation for curative surgery. Of these 25 had developed at least one episode of cholangitis within one year of diagnosis, 6 had more than one episode, while 72 did not have any episodes of cholangitis. Whipple surgery was attempted in 76% of the cholangitis-1 group compared to 78% of the non-cholangitis group (p= 1.0). The average time to surgery was 194 days in the cholangitis group and 176 days in the non-cholangitis group (p=0.40). There was no difference in surgical resection rate or time to surgery between patients with more than one episode of cholangitis compared to the non-cholangitis group. There was no difference between groups in six (p=0.57) or twelve month (p=0.56) mortality.
Discussion: Our data reveal that cholangitis within a year of diagnosis does not impact the ability of a patient to undergo successful Whipple operation. We propose that aggressive endoscopic biliary endotherapy should be considered, even in patients with recurrent preoperative cholangitis, to assist with completing neoadjuvant protocols in hopes of a curative surgery.
Citation: Eli P. Darnell, MD, Thomas J. Wang, MD, Melissa A. Lumish, MD, Yasmin G. Hernandez-Barco, MD, Maximillian Weniger, MD, C. Fernandez-Del Castillo, MD, Brenna W. Casey, MD, Kumar Krishnan, MD. P1827 - CHOLANGITIS IN PATIENTS WITH PANCREATIC ADENOCARCINOMA DOES NOT IMPACT RESECTION RATES IN PATIENTS WHO ARE UNDERGOING NEOADJUVANT CHEMOTHERAPY. Program No. P1827. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.