S194 Predictors of Survival Outcomes After Pre-Operative Biliary Drainage for Patients With Malignant Obstructive Jaundice and Pancreatic Carcinoma: A Systematic Review and Meta-Analysis

Introduction: Pancreatic cancer is the fourth leading cause of cancer-related deaths in the United States. Pre-operative biliary drainage (PBD) is often palliative, and its contribution to survival outcomes in patients with malignant biliary obstruction (MBO) is debatable. The present meta-analysis was performed to evaluate factors associated with survival outcomes among patients with pancreatic cancer and MBO. Methods: All clinical studies included patients with pancreatic cancer and developed MBO, and evaluated factors associated with survival outcomes were included. These studies have to implement the Cox regression model to calculate the hazard ratio (HR) for the time to relevant outcomes. The literature review was performed through 12 databases on 15th June 2024. Results: This study included 9 articles of retrospective design, including 2461 patients. There was a statistically significant association between PBD (P < 0.001) and overall survival with an HR of 1.22. There was a statistically significant association between percutaneous biliary drainage (HR; 1.32; 95% CI; 1.08, 1.62; P = 0.007) and overall survival. Patients with positive surgical margin (HR; 1.34, 95% CI; 1.16, 1.55, P < 0.001) and patients with venous invasion (HR; 1.21, 95% CI; 1.05, 1.41, P = 0.01) were associated with overall survival. There was a statistically significant association between lymphatic invasion (HR; 2.13, 95% CI; 1.30, 3.49, P = 0.003), perineural invasion (HR; 1.88, 95% CI; 1.31, 2.69, P = 0.006) and overall survival. Conclusion: This meta-analysis highlights that PBD is associated with poorer overall survival in patients with malignant biliary obstruction due to pancreatic cancer. In particular, percutaneous drainage appears to carry a higher risk. Additionally, pathological features such as positive surgical margins, venous invasion, lymphatic invasion, and perineural invasion were strong predictors of worse outcomes. These findings suggest the need for careful patient selection and individualized treatment planning. Further prospective studies are warranted to confirm these associations.