Clinical Impact of Preoperative Biliary Drainage in Patients with Ductal Adenocarcinoma of the Pancreatic Head

Amaral, Maria João; Freitas, José Alberto de Souza; Amaral, Mariana; Serôdio, Marco; Oliveira, Rui Caetano; Donato, Paulo; Tralhão, José Guilherme

doi:10.3390/diagnostics13071281

Cited by 4 publications

(1 citation statement)

References 59 publications

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“…This indicates that preoperative biliary drainage does not increase the frequency of postoperative complications in PD of malignant obstructive jaundice. Amaral et al's [22] study showed that compared to the Non-PBD group, the positive rate of intraoperative bill cultures in the PBD group was notable higher. Our study shows that the positive rate of bacterial culture in postoperative drainage uid in the PBD group exceed that in the Non-PBD group (19% versus 10%, P = 0.095), but the difference is not extremely obvious.…”

Section: Discussionmentioning

confidence: 97%

Comparison of short-term complications and long-term prognostic of pancreaticoduodenectomy with and without preoperative biliary drainage in malignant obstructive jaundice

Qu,

Lyu,

Kou

et al. 2023

Preprint

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Background: Malignant obstructive jaundice is a common symptom in patients with periampullary cancer. The impact of PBD on short-term complications after pancreaticoduodenectomy (PD) and the risk factors affecting long-term survival for periampullary cancer still unravel. Methods: We retrospectively collected relevant data of patients with periampullary cancer who underwent pancreaticoduodenectomy for obstructive jaundice from 2017 to 2022. We divided them into PBD group and Non PBD group based on whether preoperative biliary drainage was performed. The postoperative complications between the PBD group and the Non-PBD group was compared. Binary logistic analysis is used to identify relevant risk factors affecting complications after PD. The differences in the incidence of postoperative complications among different biliary drainage methods and duration of biliary drainage were also analyzed. Afterwards, univariate Cox and multivariate Cox regression analyses were performed to identify risk factors associated with prognosis of pancreatic cancer, common bile duct cancer, and Vater ampullary cancer. Results: A total of 165 patients were included in the analysis (PBD=84, Non PBD=81). There was no difference in age, gender, BMI, American Society of Anesthesiologists (ASA), and disease history between the PBD group and the Non PBD group. The incidence of postoperative complications in the PBD group was 55%, while in the Non PBD group it was 51%, with no statistical discrepancy (P = 0.10). The positive rate of postoperative drainage fluid culture in the PBD group was slightly higher than that in the Non-PBD group (19% versus 10%, P=0.095). Preoperative total bilirubin>200μmol/L (OR = 32.545, P ＜0.001) and prolonged surgical duration (OR = 1.006, P = 0.008) are independent risk factors for postoperative complications in PD. There was no discrepancy in the postoperative complications between the PBD ≤ 14 day subgroup and the PBD>14 day subgroup (P = 0.5), as well as between PTCD and ERCP drainage methods (P = 0.8). PBD and preoperative total bilirubin do not affect long-term survival after surgery for periampullary cancer. Conclusions Preoperative biliary drainage does not affect the incidence of postoperative complications in periampullary cancer with malignant obstructive jaundice, nor does it affect its long-term survival. Preoperative total bilirubin > 200μmol/L is an independent risk factor affecting the occurrence of complications after PD. The positive rate of postoperative drainage fluid bacterial culture in the PBD group is slightly higher than that in the Non-PBD group. Poor tumor differentiation and vein resection are common risk factors for long-term survival of pancreatic cancer and common bile duct cancer after PD.

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Section: Discussionmentioning

confidence: 97%

Comparison of short-term complications and long-term prognostic of pancreaticoduodenectomy with and without preoperative biliary drainage in malignant obstructive jaundice

Qu,

Lyu,

Kou

et al. 2023

Preprint

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The impact of preoperative biliary drainage on postoperative healthcare-associated infections and clinical outcomes following pancreaticoduodenectomy: a ten-year retrospective analysis

Yu,

Du,

Zhang

et al. 2024

BMC Infect Dis

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Background Pancreaticoduodenectomy (PD) is a complex procedure and easily accompanied by healthcare-associated infections (HAIs). This study aimed to assess the impact of PBD on postoperative infections and clinical outcomes in PD patients. Methods The retrospective cohort study were conducted in a tertiary hospital from January 2013 to December 2022. Clinical and epidemiological data were collected from HAIs surveillance system and analyzed. Results Among 2842 patients who underwent PD, 247 (8.7%) were diagnosed with HAIs, with surgical site infection being the most frequent type (n = 177, 71.7%). A total of 369 pathogenic strains were detected, with Klebsiella pneumoniae having the highest proportion, followed by Enterococcu and Escherichia coli. Although no significant association were observed generally between PBD and postoperative HAIs, subgroup analysis revealed that PBD was associated with postoperative HAIs in patients undergoing robotic PD (aRR = 2.174; 95% CI:1.011–4.674; P = 0.047). Prolonging the interval between PBD and PD could reduce postoperative HAIs in patients with cholangiocarcinoma (≥4 week: aRR = 0.292, 95% CI 0.100–0.853; P = 0.024) and robotic PD (≤2 week: aRR = 3.058, 95% CI 1.178–7.940; P = 0.022). PBD was also found to increase transfer of patients to ICU (aRR = 1.351; 95% CI 1.119–1.632; P = 0.002), extended length of stay (P < 0.001) and postoperative length of stay (P = 0.004). Conclusion PBD does not exhibit a significant association with postoperative HAIs or other outcomes. However, the implementation of robotic PD, along with a suitable extension of the interval between PBD and PD, appear to confer advantages concerning patients’ physiological recuperation. These observations suggest potential strategies that may contribute to enhanced patient outcomes.

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The Impact of Preoperative Biliary Drainage on Postoperative Healthcare-Associated Infections and Clinical Outcomes Following Pancreaticoduodenectomy: A Ten-Year Retrospective Analysis

Zhao

et al. 2023

Preprint

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Background Pancreaticoduodenectomy (PD) is a complex procedure and easily accompanied by healthcare-associated infections (HAIs). This study aimed to assess the impact of PBD on postoperative infections and clinical outcomes in PD patients. Methods The retrospective cohort study were conducted in a tertiary hospital from January 2013 to December 2022. Clinical and epidemiological data were collected from HAIs surveillance system and analyzed. Results Among 2842 patients who underwent PD, 247 (8.7%) were diagnosed with HAIs, with surgical site infection being the most frequent type (n = 177, 71.7%). A total of 369 pathogenic strains were detected, with Klebsiella pneumoniae having the highest proportion, followed by Enterococcu and Escherichia coli. Although no significant association were observed generally between PBD and postoperative HAIs, subgroup analysis revealed that PBD was associated with postoperative HAIs in patients undergoing robotic PD (aRR = 2.174; 95% CI:1.011 − 4.674; P = 0.047). Prolonging the interval between PBD and PD could reduce postoperative HAIs in patients with cholangiocarcinoma (≥ 4 week: aRR = 0.292, 95% CI 0.100 − 0.853; P = 0.024) and robotic PD (≤ 2week: aRR = 3.058, 95% CI 1.178 − 7.940; P = 0.022). PBD was also found to increase transfer of patients to ICU (aRR = 1.351; 95% CI 1.119 − 1.632; P = 0.002), extended length of stay (P < 0.001) and postoperative length of stay (P = 0.004). Conclusion PBD does not exhibit a significant association with postoperative HAIs or other outcomes. However, the implementation of robotic PD, along with a suitable extension of the interval between PBD and PD, appear to confer advantages concerning patients' physiological recuperation. These observations suggest potential strategies that may contribute to enhanced patient outcomes.

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Clinical Impact of Preoperative Biliary Drainage in Patients with Ductal Adenocarcinoma of the Pancreatic Head

Cited by 4 publications

References 59 publications

Comparison of short-term complications and long-term prognostic of pancreaticoduodenectomy with and without preoperative biliary drainage in malignant obstructive jaundice

Comparison of short-term complications and long-term prognostic of pancreaticoduodenectomy with and without preoperative biliary drainage in malignant obstructive jaundice

The impact of preoperative biliary drainage on postoperative healthcare-associated infections and clinical outcomes following pancreaticoduodenectomy: a ten-year retrospective analysis

The Impact of Preoperative Biliary Drainage on Postoperative Healthcare-Associated Infections and Clinical Outcomes Following Pancreaticoduodenectomy: A Ten-Year Retrospective Analysis

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