Comparison of short-term complications and long-term prognostic of pancreaticoduodenectomy with and without preoperative biliary drainage in malignant obstructive jaundice

Abstract

Background: Malignant obstructive jaundice is a common symptom in patients with periampullary cancer. The impact of PBD on short-term complications after pancreaticoduodenectomy (PD) and the risk factors affecting long-term survival for periampullary cancer still unravel. Methods: We retrospectively collected relevant data of patients with periampullary cancer who underwent pancreaticoduodenectomy for obstructive jaundice from 2017 to 2022. We divided them into PBD group and Non PBD group based on whether preoperative biliary drainage was performed. The postoperative complications between the PBD group and the Non-PBD group was compared. Binary logistic analysis is used to identify relevant risk factors affecting complications after PD. The differences in the incidence of postoperative complications among different biliary drainage methods and duration of biliary drainage were also analyzed. Afterwards, univariate Cox and multivariate Cox regression analyses were performed to identify risk factors associated with prognosis of pancreatic cancer, common bile duct cancer, and Vater ampullary cancer. Results: A total of 165 patients were included in the analysis (PBD=84, Non PBD=81). There was no difference in age, gender, BMI, American Society of Anesthesiologists (ASA), and disease history between the PBD group and the Non PBD group. The incidence of postoperative complications in the PBD group was 55%, while in the Non PBD group it was 51%, with no statistical discrepancy (P = 0.10). The positive rate of postoperative drainage fluid culture in the PBD group was slightly higher than that in the Non-PBD group (19% versus 10%, P=0.095). Preoperative total bilirubin>200μmol/L (OR = 32.545, P ＜0.001) and prolonged surgical duration (OR = 1.006, P = 0.008) are independent risk factors for postoperative complications in PD. There was no discrepancy in the postoperative complications between the PBD ≤ 14 day subgroup and the PBD>14 day subgroup (P = 0.5), as well as between PTCD and ERCP drainage methods (P = 0.8). PBD and preoperative total bilirubin do not affect long-term survival after surgery for periampullary cancer. Conclusions Preoperative biliary drainage does not affect the incidence of postoperative complications in periampullary cancer with malignant obstructive jaundice, nor does it affect its long-term survival. Preoperative total bilirubin > 200μmol/L is an independent risk factor affecting the occurrence of complications after PD. The positive rate of postoperative drainage fluid bacterial culture in the PBD group is slightly higher than that in the Non-PBD group. Poor tumor differentiation and vein resection are common risk factors for long-term survival of pancreatic cancer and common bile duct cancer after PD.