INR and not bilirubin levels predict postoperative morbidity in patients with malignant obstructive jaundice

Scheufele, Florian; Aichinger, Lena; Jäger, Carsten; Demir, Ihsan Ekin; Schorn, Stefan; Demir, Elke; Sargut, Mine; Friess, Helmut; Ceyhan, Güralp O.

doi:10.1016/j.amjsurg.2021.04.016

Cited by 9 publications

(4 citation statements)

References 29 publications

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“…Yet, it is limited by the sample size (72 patients). The study could not correlate MELD score as predictive factor in patients with PTBD, similar to what Scheufele et al reported when studying predictive value of MELD score in postoperative morbidity in patients with malignant obstructive jaundice 5. A larger study is needed to further investigate the predictive factors in patients with MBO, since there is a wide variation in survival length in patients with MBO; risks and benefits of PTBD need to be carefully weighed.…”

supporting

confidence: 61%

Malignant biliary obstruction and percutaneous drainage: MELD score and survival prediction

Alawneh

Farsakh

Innabi

et al. 2022

BMJ Support Palliat Care

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supporting

confidence: 61%

Malignant biliary obstruction and percutaneous drainage: MELD score and survival prediction

Alawneh

Farsakh

Innabi

et al. 2022

BMJ Support Palliat Care

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“…Based on our observation, patients with drainage duration of more than 30 days experienced more overall complications. However, a retrospective study on 304 patients by Scheufele et al showed that patients with drainage duration of > 4 weeks and < 4 weeks did not differ in survival [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

The effect of preoperative biliary drainage on postoperative complications of pancreaticoduodenectomy: a triple center retrospective study

et al. 2022

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Background Biliary obstruction which is a major complication of pancreas and periampullary tumors could result in cholangitis, coagulopathies, gastrointestinal symptoms, and impaired wound healing. Pancreaticoduodenectomy (PD) is still the standard approach for pancreas resection and imposes high risk of morbidity and mortality to patients. To reduce the high risk of PD and address the biliary obstruction, the use of preoperative biliary stenting was increased. However, available literature doubts its efficiency. Methods A total of 147 patients who underwent PD between September 2012, and February 2022, at three medical centers were identified. Patients were grouped based on biliary stent placement. Non-jaundiced patients with and without preoperative biliary drainage (PBD) were compared. Results The incidence of overall complications (34.2% versus 45.8%) and mortality (17.8% versus 24.3%) did not differ in the PBD group compared to the no PBD group. There was no difference in complications and mortality in non-jaundiced patients with and without PBD. Patients with drainage duration of > 30 days experienced more overall complications compared to patients with less than 30 days drainage duration (12 (50.0%) and three (15.8%) patients, respectively, p-value = 0.019). Conclusions PBD does not significantly increase the post-operative burden on patients who undergo PD. However, we cannot overlook the financial burden that PBD places on the patient and the healthcare system, as well as the difficulties related to endoscopic retrograde cholangiopancreatography (ERCP). Therefore, biliary stenting should not be routinely practiced in the absence of a valid indication, such as severe jaundice, pruritus, cholangitis, delayed surgery for neoadjuvant treatment, or referral to a tertiary facility.

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“…However, this did not affect 90-day mortality or five-year survival. Scheufele et al [ 41 ] have found that bilirubin level does not affect overall morbidity or long-term survival. Pamecha et al [ 42 ] reached similar conclusions, although severely jaundiced patients had increased intraoperative blood loss.…”

Section: Discussionmentioning

confidence: 99%

Five-year follow-up after pancreatoduodenectomy performed for malignancy: A single-centre study

Russell

Labib

Aroori

2022

Ann Hepatobiliary Pancreat Surg

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The aim of this study was to describe short-and long-term outcomes of patients who underwent pancreatoduodenectomy (PD) at a typical UK hepatopancreatobiliary unit. Methods: A retrospective analysis of all PD patients with histologically-confirmed pancreatic ductal adenocarcinoma (PDAC), ampullary adenocarcinoma (AA), or distal cholangiocarcinoma (CC) from September 1st, 2006 to May 31st, 2015 was carried out. The following information was obtained: demographics, comorbidities, preoperative investigations, neoadjuvant treatment, operative details, postoperative management, complications, adjuvant treatment, five-year recurrence, and five-year survival. Effects of selected preoperative variables on short-and long-term outcomes were investigated. Results: Of 271 included patients, 57.9% had PDAC, 25.8% had AA, and 16.2% had CC. In total, 67.9% experienced morbidity and 17.3% developed a Clavien-Dindo grade ≥ III complication. The 90-day mortality was 3.3%. Clinically-relevant postoperative pancreatic fistula, bile leak, gastrojejunal leak, postpancreatectomy haemorrhage and delayed gastric emptying affected 8.1%, 4.1%, 0.0%, 9.2%, and 19.9% of patients, respectively. American Society of Anesthesiologists grade III-VI correlated with overall morbidity (p = 0.002) and major morbidity (p = 0.009), but not 90-day mortality or five-year survival. The same pattern was observed in patients with a preoperative serum bilirubin > 29 µmol/L and/or a neutrophil/lymphocyte ratio > 3.1. Five-year cancer recurrence and five-year survival were 68.3% and 22.5%, respectively. PDAC patients had higher five-year recurrence but lower five-year survival rates (both p = 0.001). Conclusions: In our series, the majority of patients experienced a complication. However, few patients experienced major morbidity. Surgical risk factors did not affect five-year survival.

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INR and not bilirubin levels predict postoperative morbidity in patients with malignant obstructive jaundice

Cited by 9 publications

References 29 publications

Malignant biliary obstruction and percutaneous drainage: MELD score and survival prediction

Malignant biliary obstruction and percutaneous drainage: MELD score and survival prediction

The effect of preoperative biliary drainage on postoperative complications of pancreaticoduodenectomy: a triple center retrospective study

Five-year follow-up after pancreatoduodenectomy performed for malignancy: A single-centre study

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