Preoperative Biliary Drainage in Patients With Operable Malignant Periampulary Tumors

NCT ID: NCT04289831

Last Updated: 2020-02-28

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

150 participants

Study Classification

INTERVENTIONAL

Study Start Date

2015-08-31

Study Completion Date

2019-10-31

Brief Summary

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The impact of preoperative biliary drainage (PBD) on morbidity and mortality associated with Pancreaticoduodenectomy (PD) in patients with peri-ampulary tumors is still controversial. The objective of this study is to evaluate the impact of PBD on surgical and oncologic outcomes after PD in jaundiced patients with operable peri-ampulary tumors.

Detailed Description

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150 consecutive jaundiced patients with suspected operable peri-ampullary tumors were randomized via concealed envelopes into 2 groups (each included 75 patients), group I managed by direct surgery while group II managed by PBD followed by surgery. Both groups were compared regarding perioperative mortality, morbidities, tumor recurrence and 2 years survival rates.

Conditions

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Periampullary Cancer Biliary Obstruction Preoperative Biliary Drainage

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Caregivers

Study Groups

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Direct Surgery (DS) group

patients subjected to direct surgery (DS) within 1 week after randomization

Group Type ACTIVE_COMPARATOR

Surgery

Intervention Type PROCEDURE

The standard surgical procedure for operable tumors Whipple procedure with triple reconstruction, namely pancreatogastrostomy or pancreatojejunostomy,hepaticojejunostomy and gastrojejunostomy

Preoperative Biliary Drainage (PBD) group

patients managed by Preoperative Biliary Drainage followed by surgery after 4-6 weeks.

Group Type ACTIVE_COMPARATOR

Preoperative Biliary Drainage (PBD)

Intervention Type PROCEDURE

Endoscopic retrograde biliary drainage (ERBD) and stent placement was the first choice for PBD while ultrasound-guided percutaneous transhepatic biliary drainage (PTBD) was done if ERBD was not feasible. Biliary drainage was considered successful if the serum bilirubin level decreased by 50% or more within 2 weeks after the procedure. Patients with failed PBD were referred directly to surgery, while those with successful PBD were referred to surgery 4 to 6 weeks after first drainage procedure according to the latest guidelines

Surgery

Intervention Type PROCEDURE

The standard surgical procedure for operable tumors Whipple procedure with triple reconstruction, namely pancreatogastrostomy or pancreatojejunostomy,hepaticojejunostomy and gastrojejunostomy

Interventions

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Preoperative Biliary Drainage (PBD)

Endoscopic retrograde biliary drainage (ERBD) and stent placement was the first choice for PBD while ultrasound-guided percutaneous transhepatic biliary drainage (PTBD) was done if ERBD was not feasible. Biliary drainage was considered successful if the serum bilirubin level decreased by 50% or more within 2 weeks after the procedure. Patients with failed PBD were referred directly to surgery, while those with successful PBD were referred to surgery 4 to 6 weeks after first drainage procedure according to the latest guidelines

Intervention Type PROCEDURE

Surgery

The standard surgical procedure for operable tumors Whipple procedure with triple reconstruction, namely pancreatogastrostomy or pancreatojejunostomy,hepaticojejunostomy and gastrojejunostomy

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Serum bilirubin level above 4 mg/dl
* suspected peri-ampullary tumor at computed tomography (CT)
* No evidence of distant metastasis or locally advanced tumor

Exclusion Criteria

* Patients with evidence of distant metastasis or locally advanced tumor
* Prior neoadjuvant chemotherapy or Radiotherapy
* Prior biliary surgery
* Patients with contraindication for major surgery
Minimum Eligible Age

18 Years

Maximum Eligible Age

70 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Alexandria

OTHER

Sponsor Role lead

Responsible Party

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Mohamed El Messiry

Ass. Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Mohamed M Elmessiry, MD,PhD

Role: PRINCIPAL_INVESTIGATOR

Ass. Professor of Surgery (Surgical Oncology Unit)

Eman A Mohamed, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

Lecturer of Internal Medicine (Gastroenterology Unit)

References

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Wang C, Xu Y, Lu X. Should preoperative biliary drainage be routinely performed for obstructive jaundice with resectable tumor? Hepatobiliary Surg Nutr. 2013 Oct;2(5):266-71. doi: 10.3978/j.issn.2304-3881.2013.09.01.

Reference Type BACKGROUND
PMID: 24570957 (View on PubMed)

Mezhir JJ, Brennan MF, Baser RE, D'Angelica MI, Fong Y, DeMatteo RP, Jarnagin WR, Allen PJ. A matched case-control study of preoperative biliary drainage in patients with pancreatic adenocarcinoma: routine drainage is not justified. J Gastrointest Surg. 2009 Dec;13(12):2163-9. doi: 10.1007/s11605-009-1046-9. Epub 2009 Sep 23.

Reference Type BACKGROUND
PMID: 19774424 (View on PubMed)

Smith RA, Dajani K, Dodd S, Whelan P, Raraty M, Sutton R, Campbell F, Neoptolemos JP, Ghaneh P. Preoperative resolution of jaundice following biliary stenting predicts more favourable early survival in resected pancreatic ductal adenocarcinoma. Ann Surg Oncol. 2008 Nov;15(11):3138-46. doi: 10.1245/s10434-008-0148-z. Epub 2008 Sep 12.

Reference Type BACKGROUND
PMID: 18787902 (View on PubMed)

Abdullah SA, Gupta T, Jaafar KA, Chung YF, Ooi LL, Mesenas SJ. Ampullary carcinoma: effect of preoperative biliary drainage on surgical outcome. World J Gastroenterol. 2009 Jun 21;15(23):2908-12. doi: 10.3748/wjg.15.2908.

Reference Type BACKGROUND
PMID: 19533815 (View on PubMed)

Other Identifiers

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03027612

Identifier Type: -

Identifier Source: org_study_id