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Impact of Percutaneous Transhepatic Biliary Drainage on Clinical Outcomes of Patients with Malignant Obstructive Jaundice Undergoing Laparoscopic Pancreaticoduodenectomy

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Summary

Preoperative biliary drainage may increase the morbidity and mortality of pancreaticoduodenectomy. Studies on percutaneous transhepatic biliary drainage (PTBD) before laparoscopic pancreaticoduodenectomy (LPD), however, are scarce. The aim of this study was to examine the impact of PTBD on clinical outcomes of patients with malignant obstructive jaundice undergoing LPD. Clinical data of 172 patients who had malignant obstructive jaundice and underwent LPD from 2014 to 2017 in our hospital were retrospectively analyzed. Demographics, catheter-related complications, postoperative complications, and oncological outcomes were collected and analyzed. Propensity score matching was performed to minimize selection bias associated with the comparison of data between patients who underwent PTBD and then LPD (PTBD group), and those given LPD alone (LPD group). The results showed that, in the PTBD group relative to the LPD group, the operating time was significantly shortened (250.28±69.95 vs. 278.58±86.51 min, P=0.0196), the intraoperative blood loss was markedly reduced (271.96±403.47 vs. 429.72±482.47 mL, P=0.022), and overall rates of complications (16.33% vs. 36.49%, P=0.0025) including postoperative haemorrhage (2.04% vs. 12.16%, P=0.0072) and delayed gastric emptying (4.08% vs. 13.51%, P=0.0251) were greatly decreased. The propensity score-matched analysis, with 48 patients enrolled in each group, revealed no statistically significant differences in operating duration (262.71±68.64 vs. 280.25±83.52 min, P=0.264), intraoperative blood loss (290.21±407.71 vs. 373.75±422.33 mL, P=0.327) and delayed gastric emptying (4.17% vs. 12.50%, P=0.1396). PTBD group had lower incidences in overall complications (22.92% vs. 39.58%, P=0.0481) and postoperative haemorrhage (2.08% vs. 12.50%, P=0.0497) than LPD group. In conclusion, patients with malignant obstructive jaundice may benefit from PTBD procedure before LPD in terms of perioperative outcomes.

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References

  1. Paniccia A, Schulick RD, Edil BH. Total Laparoscopic Pancreaticoduodenectomy: A Single-Institutional Experience. Ann Surg Oncol, 2015,22(13):4380–4381

    Article  Google Scholar 

  2. Croome KP, Farnell MB, Que FG, et al. Total laparoscopic pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: oncologic advantages over open approaches? Ann Surg, 2014,260(4):633–638; discussion 8–40

    Article  Google Scholar 

  3. Saxena P, Kumbhari V, Zein ME, et al. Preoperative biliary drainage. Dig Endosc, 2015,27(2):265–277

    Article  Google Scholar 

  4. Strasberg SM, Gao F, Sanford D, et al. Jaundice: an important, poorly recognized risk factor for diminished survival in patients with adenocarcinoma of the head of the pancreas. HPB (Oxford), 2014,16(2):150–156

    Article  Google Scholar 

  5. Papadopoulos V, Filippou D, Manolis E, et al. Haemostasis impairment in patients with obstructive jaundice. J Gastrointestin Liver Dis, 2007,16(2):177–186

    PubMed  Google Scholar 

  6. van der Gaag NA, Kloek JJ, de Castro SMM, et al. Preoperative biliary drainage in patients with obstructive jaundice: history and current status. J Gastrointest Surg, 2009,13(4):814–820

    Article  CAS  Google Scholar 

  7. Moole H, Bechtold M, Puli SR. Efficacy of preoperative biliary drainage in malignant obstructive jaundice: a meta-analysis and systematic review. World J Surg Oncol, 2016,14(1):182

    Article  Google Scholar 

  8. Fang Y, Gurusamy KS, Wang Q, et al. Meta-analysis of randomized clinical trials on safety and efficacy of biliary drainage before surgery for obstructive jaundice. Br J Surg, 2013,100(12):1589–1596

    Article  CAS  Google Scholar 

  9. van der Gaag NA, Rauws EAJ, van Eijck CHJ, et al. Preoperative biliary drainage for cancer of the head of the pancreas. N Engl J Med, 2010,362(2):129–137

    Article  CAS  Google Scholar 

  10. Furukawa K, Shiba H, Shirai Y, et al. Negative Impact of Preoperative Endoscopic Biliary Drainage on Prognosis of Pancreatic Ductal Adenocarcinoma after Pancreaticoduodenectomy. Anticancer Res, 2015,35(9):5079–5083

    PubMed  Google Scholar 

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

    Article  Google Scholar 

  12. Park SY, Park CH, Cho SB, et al. What is appropriate procedure for preoperative biliary drainage in patients with obstructive jaundice awaiting pancreaticoduodenectomy? Surg Laparosc Endosc Percutan Tech, 2011,21(5):344–348

    Article  Google Scholar 

  13. Wang M, Xu S, Zhang H, et al. Imbedding pancreaticojejunostomy used in pure laparoscopic pancreaticoduodenectomy for nondilated pancreatic duct. Surg Endosc, 2017,31(4):1986–1992

    Article  Google Scholar 

  14. Bassi C, Marchegiani G, Dervenis C, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After. Surgery, 2017,161(3):584–591

    Article  Google Scholar 

  15. Wente MN, Bassi C, Dervenis C, et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery, 2007,142(5):761–768

    Article  Google Scholar 

  16. Adam MA, Thomas S, Youngwirth L, et al. Defining a Hospital Volume Threshold for Minimally Invasive Pancreaticoduodenectomy in the United States. JAMA Surg, 2017,152(4):336–342

    Article  Google Scholar 

  17. de Rooij T, Lu MZ, Steen MW, et al. Minimally Invasive Versus Open Pancreatoduodenectomy: Systematic Review and Meta-analysis of Comparative Cohort and Registry Studies. Ann Surg, 2016,264(2):257–267

    Article  Google Scholar 

  18. Nehéz L, Andersson R. Compromise of immune function in obstructive jaundice. Eur J Surg, 2002,168(6):315–328

    Article  Google Scholar 

  19. Smith RA, Dajani K, Dodd S, et al. Preoperative resolution ofjaundice following biliary stenting predicts more favourable early survival in resected pancreatic ductal adenocarcinoma. Ann Surg Oncol, 2008,15(11): 3138–3146

    Article  Google Scholar 

  20. Garcea G, Chee W, Ong SL, et al. Preoperative biliary drainage for distal obstruction: the case against revisited. Pancreas, 2010,39(2):119–126

    Article  Google Scholar 

  21. Ferrero A, Lo Tesoriere R, Viganò L, et al. Preoperative biliary drainage increases infectious complications after hepatectomy for proximal bile duct tumor obstruction. World J Surg, 2009,33(2):318–325

    Article  Google Scholar 

  22. Koyama K, Takagi Y, Ito K, et al. Experimental and clinical studies on the effect of biliary drainage in obstructive jaundice. Am J Surg, 1981,142(2):293–299

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Biliary-Pancreatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China

    He-bin Wang, Feng Peng, Min Wang, Ren-yi Qin & Feng Zhu

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  1. He-bin Wang
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  2. Feng Peng
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  3. Min Wang
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  4. Ren-yi Qin
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  5. Feng Zhu
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Correspondence to Feng Zhu.

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The authors declare that they have no conflicts of interest.

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Wang, Hb., Peng, F., Wang, M. et al. Impact of Percutaneous Transhepatic Biliary Drainage on Clinical Outcomes of Patients with Malignant Obstructive Jaundice Undergoing Laparoscopic Pancreaticoduodenectomy. CURR MED SCI 41, 375–380 (2021). https://doi.org/10.1007/s11596-021-2357-7

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  • DOI: https://doi.org/10.1007/s11596-021-2357-7

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