Impact of Neoadjuvant Chemotherapy and Pretreatment Biliary Drainage for Pancreatic Head Ductal Adenocarcinoma

Saad Saffo*, Chengwei Peng, Ronald Salem, Tamar Taddei, Anil Nagar

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Background: Pancreatic ductal adenocarcinoma (PDAC) is one of the leading causes of cancer-related deaths in the USA. Although management strategies have evolved, there are continued controversies about the use of neoadjuvant chemotherapy (NAC) and pretreatment biliary drainage (PBD) in patients with resectable and potentially resectable disease. Aims: We aimed to characterize the practice trends and outcomes for NAC and PBD. Methods: A single-center cohort study was performed. Electronic medical records were reviewed between 2011 and 2019, and 140 patients who had pancreaticoduodenectomy for PDAC were included. Diagnosis, treatment, and outcome data were captured. Results: There were no statistically significant temporal trends relating to the use of chemotherapy and PBD. Overall, 41% of patients received NAC and had improved survival, independent of other factors. Of the 71% who received PBD, only 40% had appropriate indications; 30% experienced postprocedure complications, and 34% required reintervention. Factors associated with the application of PBD included preoperative jaundice (OR 70.5, 95% CI 21.4–306.6) and evaluation by non-tertiary therapeutic endoscopists (OR 3.9, 95% CI 1.3–13.6). PBD was associated with a 12-day delay in surgery among those who did not receive NAC (p = 0.005), but there were no differences in surgical complications or mortality. Conclusions: Our findings suggest that (1) NAC may confer a survival benefit and (2) PBD should be reserved for individuals with jaundice requiring NAC. Implementation of guidelines by North American gastroenterology societies, multidisciplinary treatment models, and delivery of care at high-volume tertiary centers may help optimize management.

Original languageEnglish (US)
Pages (from-to)1409-1416
Number of pages8
JournalDigestive diseases and sciences
Issue number4
StatePublished - Apr 2022


  • Biliary drainage
  • Neoadjuvant chemotherapy
  • Pancreatic ductal adenocarcinoma
  • Pancreaticoduodenectomy

ASJC Scopus subject areas

  • Gastroenterology
  • Physiology


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