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Influence of preoperative biliary drainage on surgical outcome after pancreaticoduodenectomy: single centre experience

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Abstract

Purpose

Controversy prevails on the impact of preoperative biliary drainage (PBD) on postoperative complications and clinical outcome of pancreatic cancer. We determined whether PBD is associated with increased morbidity and mortality rates after pancreaticoduodenectomy.

Methods

A total of 131 consecutive patients who underwent pancreaticoduodenectomy (93 jaundiced, 38 with no jaundice) were included in this study. Overall, 57 % of jaundiced patients underwent PBD, while 43 % were not drained. The impact of PBD on postoperative morbidity and mortality was evaluated by means of logistic regression analysis. The Kaplan–Meier method was applied to determine the effect of PBD on survival of patients with malignant lesions.

Results

Mortality and morbidity rate was 3 % and 54.6 %, respectively. PBD was demonstrated to be the unique predictor of complications (odds ration [OR] = 10.18; 95 % confidence interval [CI], 3.65–28.39, p < 0.001). The jaundiced patients who were drained exhibited high frequencies of wound infection (p < 0.001), post-pancreatectomy haemorrhage (p = 0.0185) and hyperglycaemia (p < 0.001). In addition, an increased frequency of pancreatic fistula emerged among drained patients compared to those who were not drained (p = 0.036). PBD did not affect survival of patient with malignant lesions.

Conclusions

With the exception of the classical indications, PBD should be carefully evaluated in patients with resectable pancreatic cancer.

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Abbreviations

PBD:

Preoperative biliary drainage

PPH:

Post-pancreatectomy haemorrhage

DGE:

Delayed gastric emptying

PTC:

Percutaneous transhepatic cholangiography

ERCP:

Endoscopic retrograde cholangiopancreatography

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Acknowledgments

This study was supported by a grant from the Italian Ministry of Health (No. RC1203CH50) and by the “5×1000” voluntary contributions.

Conflicts of interest

The authors declare that they have no conflict of interest.

Authors’ contributions

Study conception and design: FFDM and PDS; Acquisition of data: RRR; Analysis of data: MRV; Interpretation of data: FT, FFDM, ADB; Drafting of manuscript: FFDM, FT; Critical revision of manuscript: PDS, AA.

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Authors and Affiliations

  1. Division of Surgical Oncology, “SS Annunziata” Hospital, 66100, Chieti, Italy

    F. Francesco di Mola & Pierluigi di Sebastiano

  2. Department of Surgery, IRCCS, Hospital “Casa Sollievo della Sofferenza”, San Giovanni Rotondo 71013, Italy

    F. Francesco di Mola, R. Rita Rago, Antonio De Bonis & Pierluigi di Sebastiano

  3. Division of Gastroenterology, IRCCS, Hospital “Casa Sollievo della Sofferenza”, San Giovanni Rotondo 71013, Italy

    Francesca Tavano, M. Rosa Valvano & Angelo Andriulli

  4. Department of Experimental and Clinical Sciences, University of Chieti, Chieti, 66100, Italy

    Francesca Tavano

Authors
  1. F. Francesco di Mola
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  2. Francesca Tavano
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  3. R. Rita Rago
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  4. Antonio De Bonis
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  5. M. Rosa Valvano
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  6. Angelo Andriulli
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  7. Pierluigi di Sebastiano
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Corresponding author

Correspondence to Pierluigi di Sebastiano.

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di Mola, F.F., Tavano, F., Rago, R.R. et al. Influence of preoperative biliary drainage on surgical outcome after pancreaticoduodenectomy: single centre experience. Langenbecks Arch Surg 399, 649–657 (2014). https://doi.org/10.1007/s00423-014-1184-8

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  • DOI: https://doi.org/10.1007/s00423-014-1184-8

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