2010
DOI: 10.1056/nejmoa0903230
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Abstract: Routine preoperative biliary drainage in patients undergoing surgery for cancer of the pancreatic head increases the rate of complications. (Current Controlled Trials number, ISRCTN31939699.)

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Cited by 899 publications
(592 citation statements)
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References 38 publications
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“…The clinical need for preoperative biliary drainage in patients with potentially curable periampullary tumors remains controversial [16,35]. The most often cited study by van der Gaag et al [16] demonstrated clearly that preoperative biliary drainage increased the morbidity. However, this study did not use SEMS, but rather plastic stents and sometimes even percutaneous transhepatic cholangiography drainage, which might induce more complications than modern SEMSs.…”
Section: Discussionmentioning
confidence: 99%
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“…The clinical need for preoperative biliary drainage in patients with potentially curable periampullary tumors remains controversial [16,35]. The most often cited study by van der Gaag et al [16] demonstrated clearly that preoperative biliary drainage increased the morbidity. However, this study did not use SEMS, but rather plastic stents and sometimes even percutaneous transhepatic cholangiography drainage, which might induce more complications than modern SEMSs.…”
Section: Discussionmentioning
confidence: 99%
“…The results of a recent multicenter randomized trial and a subsequent meta-analysis offer strong support for the view that preoperative biliary drainage is followed by an increased rate of major complications. Although many of these complications occurred postprocedurally (i. e. after stent insertion) rather than after the final operation, these authors concluded that preoperative biliary drainage in general should be avoided for resectable tumors [6,7,9,16]. Nonetheless, in spite of conflicting evidence, biliary drainage is still used for biliary decompression in selected patients with cholangitis or severe jaundice prior to radical surgery in many centers, especially for the increasing number of patients who are offered neoadjuvant therapy for pancreatic cancer [17].…”
mentioning
confidence: 99%
“…In the event of severe complications related to obstructive jaundice, the majority of authors recommend urgent treatment of hyperbilirubinemia, regardless of the origin of the disease; conversely, isolated finding of elevated serum bilirubin may not be per se an indication to perform PBD particularly in the case of malignancies involving the distal portion of common bile duct [20,37,38]. However, as far as HC is concerned, poor evidence is available and data appear discordant.…”
Section: Discussionmentioning
confidence: 99%
“…ERCP-t követően a betegek közel 73%-ánál beszélhe-tünk epeúti fertőzésről az egyik tanulmány szerint, reszekció esetén a fertőzés növeli a morbiditási értékeket [14,15].…”
Section: (Grade 2/a Erős Egyetértés)unclassified