Perioperative outcome of Whipple’s procedure with special attention to the impact of preoperative biliary drainage: a real-life scenario

Ray, Sukanta; Das, Somak; Mandal, Tuhin Subhra; Jana, Koustav; Das, Rakesh; Kumar, Dilip; Ansari, Zuber; Khamrui, Sujan

doi:10.1007/s13304-021-01038-y

Cited by 2 publications

(4 citation statements)

References 42 publications

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“…Two metanalyses concluded that PBD increases postoperative morbidity without influencing postoperative mortality [ 16 , 21 ]. Likewise, in our study, there was no significant association with the development of clinically significant POPF, POH, and IAA, which are results that agree with the literature [ 9 , 16 , 21 , 22 , 25 ], nor with the development of SSI, a discordant result [ 9 , 16 , 21 , 22 , 25 , 38 ]. Suragul et al identified PBD as an independent risk procedure for the development of SSI after pancreaticoduodenectomy (OR 3.04, 95%CI 1.36–6.79, p < 0.05) but not for organ/space infection (IAA) [ 27 ].…”

Section: Discussionsupporting

confidence: 90%

“…In our study, PBD also did not influence the development of clinically significant DGE. The literature is more controversial regarding this subject, as one metanalysis reported an increased incidence of PBD-related DGE (OR 1.21, 95%CI 1.03–1.42, p = 0.02) [ 16 ], while other studies stated the opposite [ 9 , 22 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

“…Regarding perioperative blood transfusions, the study by Ray et al showed no significant differences whether patients underwent PBD or not (25.7% vs. 21.8%, p = 0.408) [ 25 ]. Mezhir et al obtained the same results, however, and found that patients undergoing PBD lost more blood during the surgical procedure [ 38 ], and Santos et al reported that intraoperative bleeding was less significant in patients submitted to PBD [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…Some studies have shown that PBD is associated with a decrease in the rate of postoperative complications [ 8 , 13 ], while others have shown that this would be the same whether or not patients underwent PBD [ 11 , 14 , 15 ]. However, what seems to be the increasing consensus is that it leads to an increase in the rate of postoperative complications, especially infectious ones [ 9 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ]. The number of patients requiring this preoperative procedure is expected to rise due to the increasing use of neoadjuvant chemotherapy in pancreatic cancer patients [ 28 ].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2023

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Our aim was to study the association between preoperative biliary drainage (PBD) and morbidity following cephalic pancreaticoduodenectomy (CPD) for pancreatic ductal adenocarcinoma (PDAC) and its prognostic impact, which is still controversial in the literature. A retrospective study was conducted, which included 128 patients who underwent CPD for PDAC, divided into two groups: those who underwent PBD (group 1) and those who did not undergo this procedure (group 2). Group 1 was subdivided according to the drainage route: endoscopic retrograde cholangiopancreatography (ERCP), group 1.1, and percutaneous transhepatic cholangiography (PTC), group 1.2. 34.4% of patients underwent PBD, and 47.7% developed PBD-related complications, with 37% in group 1.1 and 64.7% in group 1.2 (p = 0.074). There was a significant difference between group 1 and 2 regarding bacterial colonization of the bile (45.5% vs. 3.6%, p < 0.001), but no difference was found in the colonization by multidrug-resistant bacteria, the development of Clavien–Dindo ≥ III complications, clinically relevant pancreatic fistula and delayed gastric emptying (DGE), intra-abdominal abscess, hemorrhage, superficial surgical site infection (SSI), and readmission. Between groups 1.1 and 1.2, there was a significant difference in clinically relevant DGE (44.4% vs. 5.9%, p = 0.014) and Clavien–Dindo ≥ III complications (59.3% vs. 88.2%, p = 0.040). There were no significant differences in median overall survival and disease-free survival (DFS) between groups 1 and 2. Groups 1.1 and 1.2 had a significant difference in DFS (10 vs. 5 months, p = 0.017). In this group of patients, PBD was associated with increased bacterial colonization of the bile, without a significant increase in postoperative complications or influence in survival. ERCP seems to contribute to the development of clinically significant DGE. Patients undergoing PTC appear to have an early recurrence.

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