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01-12-2017 | ORIGINAL ARTICLE

Unnecessary preoperative biliary drainage: impact on perioperative outcomes of resectable periampullary tumors

Authors: Jean-Baptiste Cazauran, Julie Perinel, Vahan Kepenekian, Michel El Bechwaty, Gennaro Nappo, Mathieu Pioche, Thierry Ponchon, Mustapha Adham

Published in: Langenbeck's Archives of Surgery | Issue 8/2017

Abstract

Objective

Routine preoperative endoscopic biliary drainage (PEBD) is not recommended for malignant periampullary tumors (MPT) with uncomplicated obstructive cholestasis, yet many patients still receive routine PEBD. Herein were assessed perioperative outcomes of routine PEBD in resectable MPT with uncomplicated biliary obstruction.

Methods

From 2008 to 2014, we identified three groups among patients undergoing surgery for resectable MPT: “unnecessary-PEBD” (despite recommendations), “necessary-PEBD” (following recommendations), and “upfront-surgery groups.” The first two groups were compared on referral patterns, drainage procedure, and post-PEBD complications; “Unnecessary-PEBD” and “upfront-surgery” groups were compared on perioperative outcomes.

Results

A total 140 patients underwent surgery for resectable MPT; 38 had cholestasis with clear PEBD indication (“necessary-PEBD”). A further 66 presented uncomplicated obstructive cholestasis with total bilirubin < 300 μmol/l, of whom 26 had unnecessary PEBD and 40 underwent upfront surgery. In total, 40.1% of PEBD were unnecessary and 64.1% were performed before surgical consultation. Time-to-surgery was significantly increased in the “unnecessary-PEBD” group by a mean ± SD 35.3 ± 5.5 days as compared to “upfront-surgery” group (95%CI [24.4–46.2]; p < 0.001). The “unnecessary-PEBD” group had a post-PEBD complication rate of 34.6%, and 7.7% were unresectable due to severe fibrosis following PEBD-induced acute pancreatitis. Perioperative severe complication rate was higher in the “unnecessary-PEBD” (73.1%) than in the “upfront-surgery” group (37.5%, p = 0.005), as was Clavien-Dindo grade > II post-operative complication rate (65.4 and 37.5%; p = 0.03).

Conclusion

Routine preoperative biliary drainage is associated with an increased morbidity and persists despite recommendations against its systematic use. Early multidisciplinary team discussions with pancreatic surgeons should be implemented with an aim to reduce unnecessary stenting and improve patient outcomes.

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Title: Unnecessary preoperative biliary drainage: impact on perioperative outcomes of resectable periampullary tumors
Authors: Jean-Baptiste Cazauran
Julie Perinel
Vahan Kepenekian
Michel El Bechwaty
Gennaro Nappo
Mathieu Pioche
Thierry Ponchon
Mustapha Adham
Publication date: 01-12-2017
Publisher: Springer Berlin Heidelberg
Published in: Langenbeck's Archives of Surgery / Issue 8/2017
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-017-1635-0

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Unnecessary preoperative biliary drainage: impact on perioperative outcomes of resectable periampullary tumors

Abstract

Objective

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

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