Preoperative biliary drainage adversely affects surgical outcomes in periampullary cancer: a retrospective and propensity score‐matched analysis. (21st January 2018)

• Record Type: Journal Article
• Authors: Lee, Hongeun; Han, Youngmin; Kim, Jae Ri; Kwon, Wooil; Kim, Sun‐Whe; Jang, Jin‐Young
• Is Part Of: Journal of hepato-biliary-pancreatic sciences. Volume 25:Number 3(2018)
• Page Start: 206
• Page End: 213
• Publication Date: 2018-01-21
• Subjects: Endoscopic retrograde cholangiopancreatography -- Interventional radiography -- Pancreatic fistula -- Postoperative complications; Liver -- Diseases -- Periodicals; Biliary tract -- Diseases -- Periodicals; Pancreas -- Diseases -- Periodicals; 617.556
• DOI: 10.1002/jhbp.529
• Languages: English
• ISSNs: 1868-6974

Abstract

Abstract: Background: The use of preoperative biliary drainage (PBD) for managing patients with periampullary cancer awaiting surgery remains controversial. The impact of PBD status and type on surgical outcomes has not been established, leading to a lack of consensus. We aimed to evaluate the impact of PBD on short‐term surgical outcomes in curatively resected periampullary cancer. Methods: We retrospectively reviewed data from patients undergoing curative periampullary cancer resection. A propensity score‐matched analysis was performed to adjust for clinical differences. Univariate and multivariate analyses were performed to determine independent risk factors for complications. Results: The overall complication rate was significantly higher in patients who underwent PBD ( P = 0.027). Additionally, complication rates were significantly higher in the endoscopic biliary drainage (EBD) group than in the percutaneous transhepatic biliary drainage (PTBD) group ( P < 0.001). After propensity score matching, overall complication rates in patients receiving EBD ( P < 0.001) were significantly higher. PBD type and diagnosis were independent risk factors for complications (hazard ratios: 1.927 for EBD; 1.921 for biliary tract cancer). Conclusions: Preoperative biliary drainage, especially EBD, should not be routinely performed in patients awaiting surgery for periampullary cancer, as it increases the risk of complications. Abstract : Highlight Lee and colleagues set out to evaluate the impact of preoperative biliary drainage according to drain status and type on short‐term surgical outcomes in patients who underwent curative resection of periampullary cancer. Endoscopic preoperative biliary drainage in particular increases the risk of postoperative complications and should not be performed routinely.