Impact of preoperative biliary drainage on postoperative outcome after pancreaticoduodenectomy: An analysis of 1500 consecutive cases

Pastena, Matteo De; Marchegiani, Giovanni; Paiella, Salvatore; Malleo, Giuseppe; Ciprani, Debora; Gasparini, Clizia; Secchettin, Erica; Salvia, Roberto; Gabbrielli, Armando; Bassi, Claudio

doi:10.1111/den.13221

Cited by 72 publications

(51 citation statements)

References 37 publications

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“…Surgical outcome is determined by several factors. As already reported, patients with bilirubin levels greater than 7.5 mg/dL showed higher postoperative AEs and morbidity . In our study, there was no difference in postoperative complications based on bilirubin level of 7.5 mg/dL (36% vs 24.1%, P = 0.39), but overall perioperative complication including stent and surgery‐related complication was significantly different between the two groups.…”

Section: Discussionmentioning

confidence: 99%

Modified non‐flared fully covered self‐expandable metal stent versus plastic stent for preoperative biliary drainage in patients with resectable malignant biliary obstruction

Lee¹,

Moon²,

Lee³

et al. 2019

J of Gastro and Hepatol

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Background and Aim Fully covered self‐expandable metal stents (FCSEMS) may be better than plastic stents (PS) for preoperative biliary drainage (PBD) to relieve cholangitis or jaundice for resectable malignant biliary obstruction (MBO). However, modification of current FCSEMS designed originally for nonresectable MBO is needed to be a proper stent for PBD. The aim of this study was to evaluate the possible superiority of non‐flared modified FCSEMS (M‐FCSEMS) with 12‐mm diameter and waist of central portion over PS in patients with resectable MBO. Methods Eighty‐five consecutive patients underwent PBD followed by operation from August 2015 to December 2017. In each M‐FCSEMS and PS group, 29 patients were matched for age, sex, body mass index, and preoperative albumin and bilirubin levels. Results The overall technical success rates of PBD using M‐FCSEMS and PS were 100%. The time to operation was similar between groups (18.6 ± 10.8 vs 19.3 ± 11.6 days, respectively; P = 0.843). The prevalence of PBD‐related adverse events (AEs) was 6.9% (2/29) in the M‐FCSEMS group versus 27.6% (8/29) in the PS group (P = 0.037). Re‐intervention before operation was required in 20.7% (6/29) of patients in the PS group but no patients in the M‐FCSEMS group (P = 0.023). No differences were found between perioperative AEs in the M‐FCSEMS and PS groups (27.5% vs 31.0%, respectively; P = 0.773). Conclusion Modified FCSEMS led to lower PBD‐related AEs, re‐intervention rate, and comparable perioperative AEs compared with PS. M‐FCSEMS may be a potential novel stent for PBD in patients with resectable MBO.

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Section: Discussionmentioning

confidence: 99%

Modified non‐flared fully covered self‐expandable metal stent versus plastic stent for preoperative biliary drainage in patients with resectable malignant biliary obstruction

Lee¹,

Moon²,

Lee³

et al. 2019

J of Gastro and Hepatol

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“…Preoperative biliary drainage by means of ERCP did not influence perioperative outcomes in the current study. However, this is a controversial topic, since this approach may lead to more infectious complications after PD (28) , although as it has been pointed by Ngu et al (29) , the avoidance of preoperative biliary drainage will prove logistically difficult for most hepato-pancreato-biliary units. A metaanalysis conducted by Wang et al (30) concluded that the current evidence neither supports nor refutes pre-operative biliary drainage for patients with obstructive jaundice needing surgery; however, this review also highlighted the heterogeneity and poor quality of most analyzed studies.…”

Section: Discussionmentioning

confidence: 99%

Pancreaticoduodenectomy With Venous Resection: An Analysis of 30-Day Morbidity and Mortality

Callejas

Concon

Rezende

et al. 2019

Arq. Gastroenterol.

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BACKGROUND: Pancreaticoduodenectomy (PD) with the resection of venous structures adjacent to the pancreatic head, even in cases of extensive invasion, has been practiced in recent years, but its perioperative morbidity and mortality are not completely determined. OBJECTIVE: To describe the perioperative outcomes of PD with venous resections performed at a tertiary university hospital. METHODS: A retrospective study was conducted, classified as a historical cohort, enrolling 39 individuals which underwent PD with venous resection from 2000 through 2016. Preoperative demographic, clinical and anthropometric variables were assessed and the main outcomes studied were 30-day morbidity and mortality. RESULTS: The median age was 62.5 years (IQ 54-68); 55% were male. The main etiology identified was ductal adenocarcinoma of the pancreas (82.1%). In 51.3% of cases, the portal vein was resected; in 35.9%, the superior mesenteric vein was resected and in the other 12.8%, the splenomesenteric junction. Regarding the complications, 48.7% of the patients presented some type of morbidity in 30 days. None of the variables analyzed was associated with higher morbidity. Perioperative mortality was 15.4% (six patients). The group of individuals who died within 30 days presented significantly higher values for both ASA (P=0.003) and ECOG (P=0.001) scores. CONCLUSION: PD with venous resection for advanced pancreatic neoplasms is a feasible procedure, but associated with high rates of morbidity and mortality; higher ASA e ECOG scores were significantly associated with a higher 30-day mortality.

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“…We read with great interest the article by De Pastena et al 1 This retrospective study identified that preoperative biliary drain does not increase major complications and mortality rates after pancreaticoduodenectomy, but it is associated with higher surgical site infection rates. Herein, we would like to raise the following points.…”

Section: Impact Of Preoperative Biliary Drainage On Postoperative Outmentioning

confidence: 98%

“…To the Editor, We appreciated the Letter by Li et al regarding our manuscript on the impact of preoperative biliary drainage (PBD) on postoperative outcomes after pancreaticoduodenectomy (PD). 1 The manuscript reflects the institutional policy of the jaundice treatment of the patients undergoing PD. Our center is a high volume center, treating patients who had often received a PBD in a country hospital.…”

Section: Reply To: Impact Of Preoperative Biliary Drainage On Postopementioning

confidence: 99%

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