Delaying surgery after preoperative biliary drainage does not increase surgical morbidity after pancreaticoduodenectomy

Yang, Feng; Jin, Chen; Zou, Caifeng; Yang, Di; Hao, Siguo; Huang, Haihui; Warshaw, Andrew L.; Fu, Deliang

doi:10.1016/j.surg.2019.07.012

Cited by 20 publications

(18 citation statements)

References 42 publications

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“…Third, the waiting time between PBD and PD in the current study is longer than other previous studies. 13,38 A prolonged waiting time might be from the congestion of the patient in the high volume center in our country, severe jaundice, and nutritional status of the patient. 39 Fourth, there was the variation of the rate of bilirubin decrease in each patient; for example, a patient displayed a good rate of bilirubin decrease in the first week, but a slower rate in the second week.…”

Section: Discussionmentioning

confidence: 99%

Association of the rate of bilirubin decrease with major morbidity in patients undergoing preoperative biliary drainage before pancreaticoduodenectomy

et al. 2021

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Objective: The objective of this study was to examine the relationship between the rate of bilirubin decrease following preoperative biliary drainage before pancreaticoduodenectomy and postoperative morbidity. Methods: Records of patients who underwent pancreaticoduodenectomy at the Department of Surgery in Ramathibodi Hospital between January 2008 and December 2019 were retrospectively reviewed. The patients were classified into either an adequate or inadequate drainage rate groups according to the bilirubin decrease rate. Major morbidity was defined as higher than grade II in the Clavien-Dindo classification. Risk factors for major morbidity were analyzed by logistic regression analysis. Results: In total, 166 patients were included in the study. Major morbidity was observed in 36 patients (21.6%). Adequate biliary drainage rate was observed in 39 patients (23.4%). Patients who had major morbidity were less likely to have come from the adequate biliary drainage rate group than the inadequate group (38.9% vs. 61.1%). However, through multivariate logistic analysis, only body mass index, operative time, and pancreatic duct diameter were independent factors associated with major morbidity, whereas the bilirubin decrease rate was not. Conclusions: Bilirubin decrease rate following preoperative biliary drainage has no significant association with major postoperative morbidity after pancreaticoduodenectomy.

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Section: Discussionmentioning

confidence: 99%

Association of the rate of bilirubin decrease with major morbidity in patients undergoing preoperative biliary drainage before pancreaticoduodenectomy

et al. 2021

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“…86 However, a recent multicenter study including 312 subjects reported higher morbidity, biliary fistulae, and hospital length of stay if surgery is performed within 4 weeks of PBD 87 and delaying surgery did not translate in greater morbidity or major complications in another study. 88 A meta-analysis of 21 studies comprising 2171 patients found earlier surgery to be significantly associated with higher resection rates. 89 The results of these studies remain subject to bias given their retrospective design and further prospective trials are needed to assess whether the shorter drainage period and lower complication rate would outweigh the shorter recovery period of the liver function.…”

Section: Duration Of Drainage Prior To Surgical Resectionmentioning

confidence: 99%

Preoperative biliary drainage for pancreatic cancer

Nehme

Lee

2021

Digestive Endoscopy

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Pancreatic adenocarcinoma is currently one of the leading causes of cancer-related morbidity and mortality with dismal long term survival after diagnosis. Nearly 85% of pancreatic cancer patients present with advanced disease precluding curative surgical resection. In those who are candidates for surgery, preoperative biliary drainage (PBD) has been developed since the 1960s in order to improve surgical outcomes. While obstructive jaundice in resectable pancreatic cancer has been traditionally treated before surgical resection in all patients, data over the past decade demonstrated increased perioperative complications and morbidity with systematic PBD compared to direct surgery. With new evidence of potential adverse events, the role of routine PBD is being reassessed. Current indications for PBD include cholangitis, delayed surgery, and relief of jaundice in patients planned to receive neoadjuvant therapy (NAT). NAT is being increasingly utilized in borderline resectable as well as resectable pancreatic cancer and a higher proportion of patients with likely require PBD in the future. The evidence for endoscopic retrograde cholangiopancreatography as first line for PBD is robust with supporting data from endoscopic ultrasound assisted biliary drainage. Selfexpanding metal stent was shown to be cost-effective in recent studies without increase in morbidity compared to plastic stents in this setting. In this review, we will summarize the current evidence for PBD in patients with pancreatic cancer.

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“…Thus, preoperative biliary drainage was introduced to reduce the negative effects of obstructive jaundice in patients with periampullary neoplasms (3). Preoperative biliary drainage by percutaneous transhepatic biliary drainage (PTBD) or endoscopic biliary drainage (EBD) is performed to improve liver functions, including immunity and coagulation, that affect perioperative recovery in jaundiced patients (4). EBD has been shown to be superior to PTBD.…”

Section: Introductionmentioning

confidence: 99%

Preoperative endoscopic retrograde biliary drainage increases postoperative complications after pancreaticoduodenectomy compared to endoscopic nasobiliary drainage

et al. 2021

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Background: Preoperative biliary drainage prior to pancreaticoduodenectomy (PD) by percutaneous transhepatic biliary drainage (PTBD) or endoscopic biliary drainage (EBD) is performed to improve liver functions, including immunity and coagulation that affect postoperative recovery in patients with jaundice.EBD can be performed through endoscopic retrograde biliary drainage (ERBD) or endoscopic nasobiliary drainage (ENBD). There is no clear consensus about which drainage is more suitable for preoperative EBD.

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Delaying surgery after preoperative biliary drainage does not increase surgical morbidity after pancreaticoduodenectomy

Cited by 20 publications

References 42 publications

Association of the rate of bilirubin decrease with major morbidity in patients undergoing preoperative biliary drainage before pancreaticoduodenectomy

Association of the rate of bilirubin decrease with major morbidity in patients undergoing preoperative biliary drainage before pancreaticoduodenectomy

Preoperative biliary drainage for pancreatic cancer

Preoperative endoscopic retrograde biliary drainage increases postoperative complications after pancreaticoduodenectomy compared to endoscopic nasobiliary drainage

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