Does Pre-operative Biliary Drainage Influence Long-Term Survival in Patients With Obstructive Jaundice With Resectable Pancreatic Head Cancer?

Shen, Ziyun; Zhang, Jun; Chen, Haoda; Wang, Weishen; Xu, Wei; Lü, Xiang; Zhou, Yiran; Zhao, Shiwei; Xu, Zhiwei; Deng, Xiaxing; Wang, Jiancheng; Weng, Yiwu; Shen, Baiyong

doi:10.3389/fonc.2020.575316

Cited by 13 publications

(14 citation statements)

References 30 publications

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“…Furthermore, our study highlights the risk of secondary surgical complications in patients with bilirubin level of > 10 mg/dl in the PBD group due to stent failure. Consistently, in previous studies a bilirubin level of greater than 7.5–15 mg/dl is reported to be associated with higher rates of post operative complications [ 1 , 27 – 29 ]. Interestingly a recent meta-analysis revealed that in bilirubin level of > 15 mg/dl, surgery outcomes do not differ in the PBD and no PBD groups [ 30 ].…”

Section: Discussionsupporting

confidence: 85%

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

et al. 2022

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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.

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Section: Discussionsupporting

confidence: 85%

“…One of pancreatic and periampullary tumors' main complications is biliary obstruction [ 1 ], which could result in cholangitis, coagulopathies, and gastrointestinal symptoms. Cholestasis precipitates bacterial growth within the bile.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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“…Preoperative biliary drainage was necessary in a higher number of VR+ cases, and this may be responsible for the significantly increased complication rate in this group of patients [ 25 ]. A higher incidence of complications after biliary drainage has been observed also in two recent meta-analyses [ 26 , 27 ]; however, the delay in surgery related to the stenting procedure does not seem to affect overall survival [ 28 , 29 ]. Furthermore, other meta-analyses have found opposite results.…”

Section: Discussionmentioning

confidence: 92%

Vascular resection for locally advanced pancreatic ductal adenocarcinoma: analysis of long-term outcomes from a single-centre series

et al. 2021

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Background Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy with poor prognosis. Radical surgery is the best option for cure and, nowadays, it is performed by many surgeons also in cases of vascular infiltration. Whether this aggressive approach to a locally advanced PDAC produces a survival benefit is under debate. Most data in the literature come from retrospective comparative studies; therefore, it is still unclear if such an extensive surgery for an advanced cancer is justified. Methods A retrospective review of patients with PDAC treated at our institution over a 12-year period was performed. Data concerning patients’ characteristics, operative details, postoperative course, and long-term survival were retrieved from prospective databases and analysed. Factors associated with poor survival were assessed via Cox regression analysis. Results A total of 173 patients with PDAC were included in the analysis, 41 subjects underwent pancreatectomy with vascular resection for locally advanced disease, and in 132 patients, only a pancreatic resection was undertaken. Demographics, major comorbidities, and tumour characteristics were similar between the two groups. Length of surgery (P=0.0006), intraoperative blood transfusions (P<0.0001), and overall complications (P<0.0001) were significantly higher in the vascular resection group. Length of hospital stay (P=0.684) and 90-day mortality (P=0.575) were comparable between groups. Overall median survival (P= 0.717) and survival rates at 1, 3, and 5 years (P=0.964, P=0.500, and P=0.445, respectively) did not differ significantly between groups. Age ≥70 years and postoperative complications were independent predictors of lower survival. Conclusions Our study confirms that pancreatectomy with vascular resection for a locally advanced PDAC is a complex operation associated with a significant longer operating time that may increase morbidity; however, in selected patients, R0 margins can be obtained with an acceptable long-term survival rate. Older patients are less likely to benefit from surgery.

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“…The authors did however investigate the effects of PBD on survival in a later study. Indeed, 56.8% of their cohort underwent PBD, with PTCD utilized more frequently than ERCP (31.7% and 25.1%, respectively) [25]. Following the inclusion of liver function tests in their multivariate analysis, PBD was shown not to affect overall survival or disease free survival [25].…”

Section: Survivalmentioning

confidence: 99%

“…Indeed, 56.8% of their cohort underwent PBD, with PTCD utilized more frequently than ERCP (31.7% and 25.1%, respectively) [25]. Following the inclusion of liver function tests in their multivariate analysis, PBD was shown not to affect overall survival or disease free survival [25]. A total serum bilirubin of >150 µmol/L pre-intervention was found to be an independent adverse prognostic factor, irrespective of PBD [25].…”

Section: Survivalmentioning

confidence: 99%

Which patients benefit from preoperative biliary drainage in resectable pancreatic cancer?

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Lahiri

Phillips

et al. 2021

Expert Review of Gastroenterology & Hepatology

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Recent studies have indicated that preoperative biliary drainage (PBD) should not be routinely performed in all patients suffering from obstructive jaundice before pancreatic surgery. The severity of jaundice that mandates PBD has yet to be defined. The evaluated paper examines the impact of PBD on intra-operative, and post-operative outcomes in patients initially presenting with severe obstructive jaundice (bilirubin ≥250 μmol/L). In this key paper evaluation, the impact of PBD versus a direct surgery (DS) approach is discussed. The arguments for and against each approach are considered with regards to drainage associated morbidity and mortality, resection rates, survival and the impact of chemotherapy and malnutrition. Concentrating on resectable head of pancreas tumors, this mini-review aims to scrutinize the authors' recommendations, alongside those of prominent papers in the field.

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Does Pre-operative Biliary Drainage Influence Long-Term Survival in Patients With Obstructive Jaundice With Resectable Pancreatic Head Cancer?

Cited by 13 publications

References 30 publications

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

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

Vascular resection for locally advanced pancreatic ductal adenocarcinoma: analysis of long-term outcomes from a single-centre series

Which patients benefit from preoperative biliary drainage in resectable pancreatic cancer?

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