Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Surgery
Published in: BMC Surgery 1/2022

Open Access 01-12-2022 | Research

The effect of preoperative biliary drainage on postoperative complications of pancreaticoduodenectomy: a triple center retrospective study

Authors: Niloufar Bineshfar, Nasser Malekpour Alamdari, Tayebeh Rostami, Alireza Mirahmadi, Adel Zeinalpour

Published in: BMC Surgery | Issue 1/2022

Login to get access

Abstract

Background

Biliary obstruction which is a major complication of pancreas and periampullary tumors could result in cholangitis, coagulopathies, gastrointestinal symptoms, and impaired wound healing. Pancreaticoduodenectomy (PD) is still the standard approach for pancreas resection and imposes high risk of morbidity and mortality to patients. To reduce the high risk of PD and address the biliary obstruction, the use of preoperative biliary stenting was increased. However, available literature doubts its efficiency.

Methods

A total of 147 patients who underwent PD between September 2012, and February 2022, at three medical centers were identified. Patients were grouped based on biliary stent placement. Non-jaundiced patients with and without preoperative biliary drainage (PBD) were compared.

Results

The incidence of overall complications (34.2% versus 45.8%) and mortality (17.8% versus 24.3%) did not differ in the PBD group compared to the no PBD group. There was no difference in complications and mortality in non-jaundiced patients with and without PBD. Patients with drainage duration of > 30 days experienced more overall complications compared to patients with less than 30 days drainage duration (12 (50.0%) and three (15.8%) patients, respectively, p-value = 0.019).

Conclusions

PBD does not significantly increase the post-operative burden on patients who undergo PD. However, we cannot overlook the financial burden that PBD places on the patient and the healthcare system, as well as the difficulties related to endoscopic retrograde cholangiopancreatography (ERCP). Therefore, biliary stenting should not be routinely practiced in the absence of a valid indication, such as severe jaundice, pruritus, cholangitis, delayed surgery for neoadjuvant treatment, or referral to a tertiary facility.
Literature
1.
Shen Z, Zhang J, Chen H, Wang W, Xu W, Lu X, et al. Does pre-operative biliary drainage influence long-term survival in patients with obstructive jaundice with resectable pancreatic head cancer? Front Oncol. 2020;10: 575316.CrossRefPubMedPubMedCentral
2.
Pavlidis ET, Pavlidis TE. Pathophysiological consequences of obstructive jaundice and perioperative management. Hepatobiliary Pancreat Dis Int. 2018;17(1):17–21.CrossRefPubMed
3.
Ammori JB, Choong K, Hardacre JM. Surgical therapy for pancreatic and periampullary cancer. Surg Clin N Am. 2016;96(6):1271–86.CrossRefPubMed
4.
Michalski CW, Liu B, Heckler M, Roth S, Sun H, Heger U, et al. Underutilization of surgery in periampullary cancer treatment. J Gastrointest Surg. 2019;23(5):959–65.CrossRefPubMed
5.
Sauvanet A, Boher JM, Paye F, Bachellier P, Sa Cuhna A, Le Treut YP, et al. Severe jaundice increases early severe morbidity and decreases long-term survival after pancreaticoduodenectomy for pancreatic adenocarcinoma. J Am Coll Surg. 2015;221(2):380–9.CrossRefPubMed
6.
Umeda J, Itoi T. Current status of preoperative biliary drainage. J Gastroenterol. 2015;50(9):940–54.CrossRefPubMed
7.
Shen Z, Zhang J, Zhao S, Zhou Y, Wang W, Shen B. Preoperative biliary drainage of severely obstructive jaundiced patients decreases overall postoperative complications after pancreaticoduodenectomy: a retrospective and propensity score-matched analysis. Pancreatology. 2020;20(3):529–36.CrossRefPubMed
8.
Sewnath ME, Birjmohun RS, Rauws EA, Huibregtse K, Obertop H, Gouma DJ. The effect of preoperative biliary drainage on postoperative complications after pancreaticoduodenectomy. J Am Coll Surg. 2001;192(6):726–34.CrossRefPubMed
9.
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.CrossRefPubMedPubMedCentral
10.
Ozgun YM, Colakoglu MK, Oter V, Piskin E, Aydin O, Aksoy E, et al. Biliary stenting prior to pancreaticoduodenectomy and its effects on postoperative outcome. Twenty years of experience with 805 patients. Arch Iran Med. 2021;24(10):771–8.CrossRefPubMed
11.
Lee H, Han Y, Kim JR, Kwon W, Kim SW, Jang JY. Preoperative biliary drainage adversely affects surgical outcomes in periampullary cancer: a retrospective and propensity score-matched analysis. J Hepatobiliary Pancreat Sci. 2018;25(3):206–13.CrossRefPubMed
12.
El Nakeeb A, Salem A, Mahdy Y, El Dosoky M, Said R, Ellatif MA, et al. Value of preoperative biliary drainage on postoperative outcome after pancreaticoduodenectomy: a case-control study. Asian J Surg. 2018;41(2):155–62.CrossRefPubMed
13.
Lassen K, Coolsen MM, Slim K, Carli F, de Aguilar-Nascimento JE, Schäfer M, et al. Guidelines for perioperative care for pancreaticoduodenectomy: enhanced recovery after surgery (ERAS®) society recommendations. World J Surg. 2013;37(2):240–58.CrossRefPubMed
14.
de Wilde RF, Besselink MG, van der Tweel I, de Hingh IH, van Eijck CH, Dejong CH, et al. Impact of nationwide centralization of pancreaticoduodenectomy on hospital mortality. Br J Surg. 2012;99(3):404–10.CrossRefPubMed
15.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.CrossRefPubMedPubMedCentral
16.
Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, 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):761–8.CrossRefPubMed
17.
Wente MN, Veit JA, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, et al. Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery. 2007;142(1):20–5.CrossRefPubMed
18.
Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M, 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):584–91.CrossRefPubMed
19.
Fang Y, Gurusamy KS, Wang Q, Davidson BR, Lin H, Xie X, 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):1589–96.CrossRefPubMed
20.
Scheufele F, Schorn S, Demir IE, Sargut M, Tieftrunk E, Calavrezos L, et al. Preoperative biliary stenting versus operation first in jaundiced patients due to malignant lesions in the pancreatic head: a meta-analysis of current literature. Surgery. 2017;161(4):939–50.CrossRefPubMed
21.
Garcia-Ochoa C, McArthur E, Skaro A, Leslie K, Hawel J. Pre-operative stenting and complications following pancreatoduodenectomy for pancreatic cancer: an analysis of the ACS-NSQIP registry. Surg Endosc. 2021;35(12):6604-6611.
22.
Werba G, Napolitano MA, Sparks AD, Lin PP, Johnson LB, Vaziri K. Impact of preoperative biliary drainage on 30 Day outcomes of patients undergoing pancreaticoduodenectomy for malignancy. HPB (Oxford). 2022;24(4):478–88.CrossRef
23.
Sahora K, Morales-Oyarvide V, Ferrone C, Fong ZV, Warshaw AL, Lillemoe KD, et al. Preoperative biliary drainage does not increase major complications in pancreaticoduodenectomy: a large single center experience from the Massachusetts General Hospital. J Hepatobiliary Pancreat Sci. 2016;23(3):181–7.CrossRefPubMed
24.
Gong L, Huang X, Wang L, Xiang C. The effect of preoperative biliary stents on outcomes after pancreaticoduodenectomy: a meta-analysis. Medicine. 2020;99(42): e22714.CrossRefPubMedPubMedCentral
25.
van der Gaag NA, Rauws EA, van Eijck CH, Bruno MJ, van der Harst E, Kubben FJ, et al. Preoperative biliary drainage for cancer of the head of the pancreas. N Engl J Med. 2010;362(2):129–37.CrossRefPubMed
26.
Chu J, He S, Ke Y, Liu X, Wang P, Zhang W, et al. The effect of preoperative biliary drainage with or without pancreatic stenting on complications after pancreatoduodenectomy: a retrospective cohort study. Biomed Res Int. 2021;2021:5572395.CrossRefPubMedPubMedCentral
27.
De Pastena M, Marchegiani G, Paiella S, Malleo G, Ciprani D, Gasparini C, et al. Impact of preoperative biliary drainage on postoperative outcome after pancreaticoduodenectomy: an analysis of 1500 consecutive cases. Digest Endosc. 2018;30(6):777–84.CrossRef
28.
Gao Z, Wang J, Shen S, Bo X, Suo T, Ni X, et al. The impact of preoperative biliary drainage on postoperative outcomes in patients with malignant obstructive jaundice: a retrospective analysis of 290 consecutive cases at a single medical center. World J Surg Oncol. 2022;20(1):7.CrossRefPubMedPubMedCentral
29.
Bolm L, Petrova E, Woehrmann L, Werner J, Uhl W, Nuessler N, et al. The impact of preoperative biliary stenting in pancreatic cancer: a case-matched study from the German nationwide pancreatic surgery registry (DGAV StuDoQ|Pancreas). Pancreatology. 2019;19(7):985–93.CrossRefPubMed
30.
Gong S, Song S, Cheng Q, Huang Y, Tian H, Jing W, et al. Efficacy and safety of preoperative biliary drainage in patients undergoing pancreaticoduodenectomy: an updated systematic review and meta-analysis. Expert Rev Gastroenterol Hepatol. 2021;15(12):1411–26.CrossRefPubMed
31.
Scheufele F, Aichinger L, Jäger C, Demir IE, Schorn S, Demir E, et al. INR and not bilirubin levels predict postoperative morbidity in patients with malignant obstructive jaundice. Am J Surg. 2021;222(5):976–82.CrossRefPubMed
32.
Watanabe J, Miki A, Sasanuma H, Kotani K, Sata N. Metal vs plastic stents for preoperative biliary drainage in patients with periampullary cancer: an updated systematic review and meta-analysis. J Hepatobiliary Pancreat Sci. 2022;00:1–15.
33.
Tol JA, van Hooft JE, Timmer R, Kubben FJ, van der Harst E, de Hingh IH, et al. Metal or plastic stents for preoperative biliary drainage in resectable pancreatic cancer. Gut. 2016;65(12):1981–7.CrossRefPubMed
34.
Lee PJ, Podugu A, Wu D, Lee AC, Stevens T, Windsor JA. Preoperative biliary drainage in resectable pancreatic cancer: a systematic review and network meta-analysis. HPB (Oxford). 2018;20(6):477–86.CrossRef
Metadata
Title
The effect of preoperative biliary drainage on postoperative complications of pancreaticoduodenectomy: a triple center retrospective study
Authors
Niloufar Bineshfar
Nasser Malekpour Alamdari
Tayebeh Rostami
Alireza Mirahmadi
Adel Zeinalpour
Publication date
01-12-2022
Publisher
BioMed Central
Published in
BMC Surgery / Issue 1/2022
Electronic ISSN: 1471-2482
DOI
https://doi.org/10.1186/s12893-022-01853-z

Other articles of this Issue 1/2022

BMC Surgery 1/2022 Go to the issue

Case report

Hemorrhagic shock caused by preoperative computed tomography-guided microcoil localization of lung nodules: a case report

Correction

Correction: Micromotion‑based balanced drilling technology to increase near cortical strain

Research

Comparison of surgical smoke between two approaches for endoscopic thyroidectomy and open thyroidectomy

Research

Comparison of advanced techniques for local excision of rectal lesions: a case series

Research article

Clip-guided local duodenectomy for safe and minimal local resection of nonampullary duodenal neoplasms

Research

Thoracoscopic posterior tracheopexy during primary esophageal atresia repair ameliorate tracheomalacia in neonates: a single-center retrospective comparative cohort study