The Significance and Associated Risk Factors of Acute Cholangitis during Neoadjuvant Chemo (Radiation) Therapy in Patients with Pancreatic and Biliary Tract Cancer

Abstract

Aim: To evaluate the disease state of acute cholangitis during preoperative treatment (AC during NAC), the effect on preoperative treatment and perioperative state, and clarify the associated risk factors in patients with pancreatic and biliary tract cancer. Methods: We retrospectively reviewed the records of patients who had undergone preoperative treatment for pancreatic or biliary tract cancer. We evaluated: 1. The comparisons of the frequency and severity of AC during NAC between pancreatic and biliary tract cancer; 2. The effect on NAC itself and perioperative status; and 3. The risk factors of AC during NAC. Results: 1. The frequency of AC during NAC was 36% for pancreatic cancer and 34% for biliary tract cancer. The average number of AC during NAC in biliary tract cancer was more often than those in pancreatic cancer (p=0.018). The coexistence rate of DIC and a severe grade were only noted in AC during NAC patients with biliary tract cancer. 2. The relative dose intensity (RDI) and complete rate of NAC were significantly reduced in patients with biliary tract cancer. There was a significant difference in the complication rate between the AC during NAC group and the Non cholangitis group. In addition, there was no mortality. 3. The significant risk factor of AC during NAC was cN1 in pancreatic cancer, and a low lymphocyte count of and high levels of ALP in biliary tract cancer. Conclusion: AC during NAC was more frequently noted in biliary tract cancer. It induces reduction of the dose of anticancer drugs and prolongation of preoperative treatment period. The low lymphocyte count and the elevated levels of hepatobiliary enzymes indicated high risk patients for AC during NAC.