Survival Advantage of Upfront Surgery for Pancreatic Head Cancer Without Preoperative Biliary Drainage

IntroductionLevel 1 evidence from randomized trials demonstrates less complication when jaundiced patients with resectable pancreatic cancer proceed directly to surgery, rather than undergo preoperative biliary drainage (PBD) first. Although “fast track” surgery significantly increases the resectability rate, it is unknown whether this translates into a survival benefit. This study evaluated the effect of upfront surgery on long-term survival using an intention-to-treat (ITT) analysis.MethodsPatients were identified from a prospectively maintained database, stratified according to whether or not they underwent PBD.ResultsAmong 157 patients, 84 (54%) underwent PBD. Of these, 73% underwent surgery, compared to 100% of those without PBD (p