Comparison of Clinical Outcome and Cost-Effectiveness after Various Preoperative Biliary Drainage Methods in Periampullary Cancer with Obstructive Jaundice.
10.3346/jkms.2012.27.4.356
- Author:
Suk Kyun HONG
1
;
Jin Young JANG
;
Mee Joo KANG
;
In Woong HAN
;
Sun Whe KIM
Author Information
1. Department of Surgery & Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea. jangjy4@snu.ac.kr
- Publication Type:Original Article ; Comparative Study ; Research Support, Non-U.S. Gov't
- Keywords:
Drainage;
Biliary Cancer;
Jaundice;
Preoperative;
Pancreatoduodenectomy
- MeSH:
Aged;
Bilirubin/blood;
Common Bile Duct Neoplasms/complications/economics/*surgery;
Cost-Benefit Analysis;
*Drainage;
Female;
Humans;
Jaundice, Obstructive/complications/*diagnosis;
Male;
Middle Aged;
Pancreatic Neoplasms/complications/economics/*surgery;
Pancreaticoduodenectomy;
Postoperative Complications;
Preoperative Care/*economics;
Retrospective Studies;
Time Factors;
Treatment Outcome
- From:Journal of Korean Medical Science
2012;27(4):356-362
- CountryRepublic of Korea
- Language:English
-
Abstract:
The aim of this study was to compare the clinical outcome and cost-effectiveness of preoperative biliary drainage (BD) methods in periampullary cancer, and to suggest guidelines for selecting the appropriate preoperative BD method. Between October 2004 and August 2010, 211 patients underwent pancreatoduodenectomy after preoperative BD. Clinical outcome and cost-effectiveness of the preoperative BD methods were compared based on the final drainage method used and on intention-to-treat analysis. There was no significant difference in drainage duration between percutaneous transhepatic biliary drainage (PTBD) and endoscopic BD groups (14.2 vs 16.6 days, respectively; P = 0.121) but daily diminution of serum bilirubin level was higher in the PTBD group (0.7 vs 0.6 mg/dL/day, respectively; P = 0.041). Based on intention-to-treat analysis, drainage duration was shorter (13.2 vs 16.5 days, respectively; P = 0.049), daily diminution of serum bilirubin level was higher (0.7 vs 0.6 mg/dL/day, respectively; P = 0.041). Medical care cost was lower (14.2 vs 15.7 x 10(3) USD, respectively; P = 0.040) in the PTBD group than in the endoscopic BD group. When selecting the preoperative BD method, practitioners should consider that PTBD is more cost-effective and safer than endoscopic BD.
