Optimal timing of pancreaticoduodenectomy following preoperative biliary drainage considering major morbidity and postoperative survival

Abstract

BackgroundThe present study aimed to determine the optimal timing of pancreaticoduodenectomy (PD) following preoperative biliary drainage (PBD) with consideration of postoperative morbidity and survival.MethodsBetween January 2007 and December 2015, consecutive 1,568 patients underwent PD at a single institution. Their data were reviewed retrospectively.ResultsOf all, 831 patients underwent PBD. The mean duration between drainage and surgery was 16.9 days. Regarding postoperative outcomes, length of hospital stay was longer in the drainage group (P = 0.028). Postoperative pancreatic fistula was not significantly different between the non‐drainage and drainage groups (P = 0.162), but major complications occurred more frequently in the drainage group (P = 0.002). Multivariable analysis showed major complications occurred significantly at third and fourth weeks (odds ratios 1.863 and 2.523) after PBD, whereas early surgery performed in the first 2 weeks did not noticeably increase postoperative complications. In multivariable survival comparison, weekly interval beyond 6 weeks was associated with poor survival in those with pancreatic cancer, while patients with bile duct cancer operated on at the fourth week showed worse prognosis.ConclusionsEarly surgery that reduces the operative delay after PBD may improve both short‐ and long‐term postoperative outcomes in cancer patients undergoing PBD.

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

“… 26 However, most patients did not reach this rate in real clinical practice. 9 , 13 , 24 Thus, a cutoff point of more than 20% bilirubin decrease within 7 days suggested by the European Society of Gastrointestinal Endoscopy (ESGE) guideline was adopted in this study as an adequate bilirubin drainage. 20 The current study’s result showed that patients who had major morbidity were less likely to have come from the adequate biliary drainage rate group than the inadequate group.…”

Does Pre-operative Biliary Drainage Influence Long-Term Survival in Patients With Obstructive Jaundice With Resectable Pancreatic Head Cancer?

“…Thus, previous studies of the impact of PBD on long-term survival in all patients have suffered from shortcomings in the methods used to select cases. Furthermore, the duration of PBD, which was rarely included in the previous research, may also influence the long-term outcome in patients with obstructive jaundice based on the recent studies ( 14 , 15 ).…”

The Impact of Preoperative Biliary Drainage on Postoperative Outcomes of Patients with Malignant Obstructive Jaundice: A Retrospective Analysis of 290 Consecutive Cases at a Single Medical Center

“…Actually, in recent years, several PBD methods were simultaneously employed, and new drainage brackets are coming onto the scene [17,18]. The management of obstructive jaundice is complicated and involves not only surgeons and medical centers but also the entire healthcare system [19]. Hegel's principle "what exists is reasonable" is thought to be applicable worldwide, but we found a more accurate observation by examining the current methods in some clinical settings.…”