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Preoperative Biliary Drainage of Severely Jaundiced Patients Increases Morbidity of Pancreaticoduodenectomy: Results of a Case-Control Study

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An Erratum to this article was published on 08 November 2014

Abstract

Background

Recent studies have indicated that preoperative biliary drainage (PBD) should not be routinely performed in patients suffering from obstructive jaundice before surgery. The severity of jaundice that mandates PBD has yet to be defined. Our aim was to investigate whether PBD is truly justified in severely jaundiced patients before pancreaticoduodenectomy. The parameters evaluated were overall morbidity, length of hospital stay, and total in-hospital mortality.

Methods

From January 2000 to December 2012, a total of 240 patients underwent pancreaticoduodenectomy for periampullary tumors. Group A comprised 76 patients with preoperative serum bilirubin ≥15 mg/dl who did not undergo PBD before surgery. Group B comprised another 76 patients, matched for age and tumor localization (papillary vs. pancreatic head) who underwent PBD 2–4 weeks before pancreaticoduodenectomy and were identified from the same database.

Results

Less operative time was required in the ‘no PBD’ group compared with the ‘PBD’ group (210 vs. 240 min). Total intraoperative blood loss and blood transfusions were also significantly less in the ‘no PBD’ group. There was no difference detected in the rate of pancreatic fistula or biliary fistula formation. Group A patients demonstrated significantly lower morbidity than group B (24 vs. 36 %, respectively) and therefore required briefer hospitalization (11 vs. 16 days). Mild infectious complications appear to be the main factor that enhanced morbidity in the PBD group. However, total in-hospital mortality was not significantly different between the two groups.

Conclusions

Even severe jaundice should not be considered as an indication for PBD before pancreaticoduodenectomy, as PBD increases infections and postoperative morbidity, therefore delaying definite treatment.

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References

  1. Whipple AO, Parsons WB, Mullins CR (1935) Treatment of carcinoma of the ampulla of Vater. Ann Surg 102(4):763–779

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  2. Smyrniotis V, Arkadopoulos N, Kyriazi MA, Derpapas M, Theodosopoulos T, Gennatas C, Kondi-Paphiti A, Vassiliou I (2010) Does internal stenting of the pancreaticojejunostomy improve outcomes after pancreatoduodenectomy? A prospective study. Langenbecks Arch Surg 395(3):195–200

    Article  Google Scholar 

  3. Tol JA, Busch OR, van der Gaag NA, van Gulik TM, Gouma DJ (2012) The quandary of preresection biliary drainage for pancreatic cancer. Cancer J 18(6):550–554

    Article  PubMed  Google Scholar 

  4. Fang Y, Gurusamy KS, Wang Q, Davidson BR, Lin H, Xie X, Wang C (2012) Pre-operative biliary drainage for obstructive jaundice. Cochrane Database Syst Rev 9:CD005444

    PubMed Central  PubMed  Google Scholar 

  5. Iacono C, Ruzzenente A, Campagnaro T, Bortolasi L, Valdegamberi A, Guglielmi A (2013) Role of preoperative biliary drainage in jaundiced patients who are candidates for pancreatoduodenectomy or hepatic resection: highlights and drawbacks. Ann Surg 257(2):191–204

    Article  PubMed  Google Scholar 

  6. Singhirunnusorn J, Roger L, Chopin-Laly X, Lepilliez V, Ponchon T, Adham M (2013) Value of preoperative biliary drainage in a consecutive series of resectable periampullary lesions. From randomized studies to real medical practice. Langenbecks Arch Surg 398(2):295–302

    Article  PubMed  Google Scholar 

  7. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213

    Article  PubMed Central  PubMed  Google Scholar 

  8. Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M, International Study Group on Pancreatic Fistula Definition (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138(1):8–13

    Article  PubMed  Google Scholar 

  9. Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Traverso LW, Yeo CJ, Büchler MW (2007) Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 142(5):761–768

    Article  PubMed  Google Scholar 

  10. Wente MN, Veit JA, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Yeo CJ, Büchler MW (2007) Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery 142(1):20–25

    Article  PubMed  Google Scholar 

  11. Prado IB, dos Santos MH, Lopasso FP, Iriya K, Laudanna AA (2003) Cholestasis in a murine experimental model: lesions include hepatocyte ischemic necrosis. Rev Hosp Clin Fac Med Sao Paulo 58(1):27–32

    Article  PubMed  Google Scholar 

  12. Bonin EA, Baron TH (2011) Preoperative biliary stents in pancreatic cancer. J Hepatobiliary Pancreat Sci 18(5):621–629

    Article  PubMed  Google Scholar 

  13. Isla AM, Griniatsos J, Riaz A, Karvounis E, Williamson RC (2007) Pancreaticoduodenectomy for periampullary malignancies: the effect of bile colonization on the postoperative outcome. Langenbecks Arch Surg 392(1):67–73

    Article  PubMed  Google Scholar 

  14. Kloek JJ, Heger M, van der Gaag NA, Beuers U, van Gulik TM, Gouma DJ, Levi M (2010) Effect of preoperative biliary drainage on coagulation and fibrinolysis in severe obstructive cholestasis. J Clin Gastroenterol 44(9):646–652

    PubMed  Google Scholar 

  15. Povoski SP, Karpeh MS Jr, Conlon KC, Blumgart LH, Brennan MF (1999) Association of preoperative biliary drainage with postoperative outcome following pancreaticoduodenectomy. Ann Surg 230(2):131–142

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  16. Sohn TA, Yeo CJ, Cameron JL, Pitt HA, Lillemoe KD (2000) Do preoperative biliary stents increase postpancreaticoduodenectomy complications? J Gastrointest Surg 4(3):258–267 discussion 267-8

    Article  CAS  PubMed  Google Scholar 

  17. Mezhir JJ, Brennan MF, Baser RE, D’Angelica MI, Fong Y, DeMatteo RP, Jarnagin WR, Allen PJ (2009) A matched case-control study of preoperative biliary drainage in patients with pancreatic adenocarcinoma: routine drainage is not justified. J Gastrointest Surg 13(12):2163–2169

    Article  PubMed  Google Scholar 

  18. van der Gaag NA, Rauws EA, van Eijck CH, Bruno MJ, van der Harst E, Kubben FJ, Gerritsen JJ, Greve JW, Gerhards MF, de Hingh IH, Klinkenbijl JH, Nio CY, de Castro SM, Busch OR, van Gulik TM, Bossuyt PM, Gouma DJ (2010) Preoperative biliary drainage for cancer of the head of the pancreas. N Engl J Med 362(2):129–137

    Article  PubMed  Google Scholar 

  19. Kozarek R (2013) Role of preoperative palliation of jaundice in pancreatic cancer. J Hepatobiliary Pancreat Sci 20(6):567–572

  20. Eshuis WJ, van der Gaag NA, Rauws EA et al (2010) Therapeutic delay and survival after surgery for cancer of the pancreatic head with or without preoperative biliary drainage. Ann Surg 252(5):840–849

    Article  PubMed  Google Scholar 

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Conflict of interest

The authors declare no conflict of interest.

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Authors and Affiliations

  1. 4th Department of Surgery, University of Athens Medical School, Attikon Hospital, 1 Rimini Str, Chaidari, 12462, Athens, Greece

    Nikolaos Arkadopoulos, Maria A. Kyriazi, Pantelis Vasiliou, Christos Lappas & Vassilios Smyrniotis

  2. Hepatogastroenterology Unit, 2nd Department of Internal Medicine, University of Athens Medical School, Attikon Hospital, Athens, Greece

    Ioannis S. Papanikolaou

  3. 1st Department of Anaesthesiology, University of Athens Medical School, Aretaieion Hospital, Athens, Greece

    Kassiani Theodoraki

  4. 2nd Department of Radiology, University of Athens Medical School, Attikon Hospital, Athens, Greece

    Nikolaos Oikonomopoulos

Authors
  1. Nikolaos Arkadopoulos
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  2. Maria A. Kyriazi
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  3. Ioannis S. Papanikolaou
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  4. Pantelis Vasiliou
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  5. Kassiani Theodoraki
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  6. Christos Lappas
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  7. Nikolaos Oikonomopoulos
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  8. Vassilios Smyrniotis
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Correspondence to Maria A. Kyriazi.

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Arkadopoulos, N., Kyriazi, M.A., Papanikolaou, I.S. et al. Preoperative Biliary Drainage of Severely Jaundiced Patients Increases Morbidity of Pancreaticoduodenectomy: Results of a Case-Control Study. World J Surg 38, 2967–2972 (2014). https://doi.org/10.1007/s00268-014-2669-x

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  • DOI: https://doi.org/10.1007/s00268-014-2669-x

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