The role of preoperative biliary drainage on postoperative outcome after pancreaticoduodenectomy in patients with obstructive jaundice

Zhu, Lingli; Yang, Yong; Cheng, Hui‐Ming; Cai, Zhenning; Tang, Neng; Liang, Mao; Fang, Xu; Qiu, Yudong

doi:10.21037/gs-22-648

Cited by 6 publications

(2 citation statements)

References 71 publications

(78 reference statements)

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“…Nagaraj et al (16) reported two cases of central hepatectomy with liver parenchyma preservation, which increased 55 and 25% of remnant liver volumes, respectively, and avoided liver failure. Preoperative biliary drainage (PBD) is a controversial procedure (17). A previous study reported that PBD increases risk of postoperative infection and does not improve the mortality and complication rate following hepatectomy (18).…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic hepatopancreatoduodenectomy for synchronous intrahepatic and extrahepatic cholangiocarcinoma: A case report

Wu,

Bai,

2023

Oncol Lett

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Laparoscopic hepatopancreatoduodenectomy (LHPD) is a complex surgical procedure with high rates of complications and mortality and is performed in a limited number of medical centers. The present study reports a case of a synchronous primary malignant tumor of the left hepatic common bile ducts. A 63-year-old male was admitted to Affiliated Jinhua Hospital, Zhejiang University School of Medicine (Jinhua, China) with a 1 week history of right upper abdominal distension and pain associated with yellow sclera. Preoperative CT and MRI imaging demonstrated a synchronous primary malignant tumor of the left hepatic and common bile ducts; therefore, laparoscopic left hemihepatectomy and pancreaticoduodenectomy were performed. There was no biliary or pancreatic leakage following the operation and the patient was discharged 16 days later. Postoperative pathology verified that the synchronous primary cholangiocarcinoma originated in the left hepatic and common bile ducts. Therefore, LHPD for synchronous primary cholangiocarcinoma may be a safe and feasible treatment for this condition.

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Section: Discussionmentioning

confidence: 99%

Laparoscopic hepatopancreatoduodenectomy for synchronous intrahepatic and extrahepatic cholangiocarcinoma: A case report

Wu,

Bai,

2023

Oncol Lett

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“…[ 5 ] As a result, guidelines[ 6 7 ] advise avoiding regular PBD in patients with pancreatic head cancer and obstructive jaundice, based on the findings mentioned above and other studies. [ 8 9 10 ]…”

Section: Introductionmentioning

confidence: 99%

Value of preoperative biliary drainage in pancreatic head cancer patients with severe obstructive jaundice: A multicenter retrospective study

Lu,

Chen,

Qin

et al. 2023

Saudi Journal of Gastroenterology

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Background: Pancreatic head cancer accompanied by obstructive jaundice is a common clinical situation. The aim of this study was to assess the impact of preoperative biliary drainage (PBD) on clinical outcomes in patients with severe obstructive jaundice. Methods: Patients with a bilirubin level of ≥250 mmol/L at diagnosis who underwent PBD were included. The primary endpoints and secondary endpoints were the postoperative severe complications rates. Secondary endpoints were the degree of improvement in general condition, predictors of severe postoperative complications, and the impact of PBD on patients with bilirubin levels >300 mmol/L. Results: In total, 289 patients were included, and 188 patients (65.1%) underwent PBD. The patients who met the American Society of Anesthesiologists (ASA) classification II–III stages decreased from 119 to 100 (P = 0.047) after PBD. The overall severe complications were significantly more frequent in the direct surgery (DS) group than in the PBD group (34.7% vs. 22.9%, P = 0.031), especially the postoperative hemorrhage (6/43 [14.0%] vs. 9/35 [25.7%], P = 0.038) and intra-abdominal infection (6/43 [14.0%] vs. 10/35 [28.6%], P = 0.018). The ASA classifications II–III (odds ratio [OR]=2.89, 95% confidence interval [CI]: 1.38–4.31), P = 0.01) and DS (OR = 3.65, 95% CI: 1.45–7.08; P = 0.003) were independently associated with severe postoperative complications. The occurrence rate of severe postoperative complications in patients with a bilirubin level >300 mmol/L who underwent PBD was significantly lower than in patients who underwent DS (25.6% vs. 40.6%, P = 0.028), but the benefit of PBD was not observed in patients who had a bilirubin level between 250 and 300 mmol/L. Conclusion: PBD is useful in reducing severe postoperative complications, especially in patients with bilirubin levels >300 mmol/L.

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Antibiotic prophylaxis with piperacillin–tazobactam reduces organ/space surgical site infection after pancreaticoduodenectomy: a retrospective and propensity score-matched analysis

Yang,

Sheng,

Cai

et al. 2024

BMC Cancer

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Background The occurrence of surgical site infection (SSI) after pancreaticoduodenectomy (PD) is still relatively high. The aim of this retrospective study is to evaluate the efficacy of piperacillin-tazobactam as perioperative prophylactic antibiotic on organ/space SSI for patients underwent PD. Methods Four hundred seven consecutive patients who underwent PD between January 2018 and December 2022 were enrolled and analyzed retrospectively. The univariate and multivariate analysis were used to identify independent risk factors of organ/space SSI. Postoperative complications were compared between the two groups according to the use of prophylactic antibiotics by a ratio of 1:1 propensity score-matched (PSM) analysis. Results Based on perioperative prophylactic antibiotic use, all 407 patients were divided into the ceftriaxone group (n = 192, 47.2%) and piperacillin–tazobactam group (n = 215, 52.8%). The rate of organ/space SSI was 31.2% with the choice of perioperative antibiotics (OR = 2.837, 95%CI = 1.802–4.465, P < 0.01) as one of independent risk factors. After PSM, there were similar baseline characteristics among the groups. Meanwhile, the piperacillin–tazobactam group had a significant lower rate of organ/space SSI compared to the ceftriaxone group both before and after PSM(P < 0.05). Conclusions The adoption of piperacillin–tazobactam as perioperative prophylaxis for patients underwent PD reduced organ/space SSI significantly.

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The role of preoperative biliary drainage on postoperative outcome after pancreaticoduodenectomy in patients with obstructive jaundice

Cited by 6 publications

References 71 publications

Laparoscopic hepatopancreatoduodenectomy for synchronous intrahepatic and extrahepatic cholangiocarcinoma: A case report

Laparoscopic hepatopancreatoduodenectomy for synchronous intrahepatic and extrahepatic cholangiocarcinoma: A case report

Value of preoperative biliary drainage in pancreatic head cancer patients with severe obstructive jaundice: A multicenter retrospective study

Antibiotic prophylaxis with piperacillin–tazobactam reduces organ/space surgical site infection after pancreaticoduodenectomy: a retrospective and propensity score-matched analysis

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