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

Blacker, Sarah; Lahiri, Rajiv; Phillips, Mary; Pinn, G; Pencavel, T.; Kumar, Rajesh; Riga, A.; Worthington, Tim; Karanjia, N D; Frampton, Adam E.

doi:10.1080/17474124.2021.1915127

Cited by 7 publications

(2 citation statements)

References 41 publications

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“…Preoperative biliary drainage in pancreatic cancer in the absence of cholangitis or any other factors precluding a timely surgery is generally not recommended, as evident from current literature [ 9 ]. But drainage based on serum bilirubin level is still controversial [ 10 , 11 ]. Our survey results reflect this controversy, with 56.4% of the surgeons believing high serum bilirubin level is an indication of biliary drainage…”

Section: Discussionmentioning

confidence: 99%

The Practice of Pancreatoduodenectomy in India: A Nation-Wide Survey

Kaushal¹,

Rakesh²,

Mathew³

et al. 2023

Cureus

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The way pancreatoduodenectomy (PD) is performed can vary a lot around the world, and there is no agreedupon standard approach. To learn more about how PD is practised in India, a survey was conducted among Indian surgeons to gather information about their current practices. MethodsA survey was created and shared with surgeons in India who practice pancreatic surgery. It had 33 questions that aimed to capture information about different aspects of PD practice. These questions covered topics such as the surgeons' education and experience, how they evaluated patients before surgery, what they considered during the operation, and how they managed patients after surgery. ResultsA total of 129 surgeons were sent the survey, and 110 of them completed it. The results showed that 40.9% of the surgeons had less than five years of experience, and 36.4% of them performed more than 15 PDs in a year. When deciding whether to perform preoperative biliary drainage, 60% of surgeons based their decision on the level of bilirubin in the patient's blood, while the rest considered other specific indications. The majority of surgeons (72.7%) looked at the trend of albumin levels to assess the patient's nutritional status before surgery. Venous infiltration was seen as a reason for neoadjuvant therapy by 76.4% of the participants, whereas 95.5% considered upfront surgery in cases of venous abutment. When it came to the type of PD, 40% preferred classical PD, 40.9% preferred pylorus-resecting PD (PRPD), and the rest chose pylorus-preserving PD (PPPD). Pancreatojejunostomy (PJ) was the preferred method for 77.3% of surgeons, while 6.3% preferred pancreatogastrostomy (PG). About 65.5% of surgeons used octreotide selectively during the operation when the duct diameter was small. Nearly all surgeons (94.5%) preferred to secure feeding access during PD, and all of them placed intraperitoneal drains. As for postoperative care, 37.3% of surgeons attempted early oral feeding within 48 hours, while 28.2% preferred to wait at least 48 hours before initiating oral feeds. ConclusionsThe survey revealed significant differences in how PD is practised among surgeons in India, highlighting the heterogeneity in their approaches and preferences.

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Section: Discussionmentioning

confidence: 99%

The Practice of Pancreatoduodenectomy in India: A Nation-Wide Survey

Kaushal¹,

Rakesh²,

Mathew³

et al. 2023

Cureus

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“…Patients' data were prospectively collected, including: General and preoperative information: Demographic characteristics (sex, age, height, weight, body mass index [BMI], and medical history), tumor location (periampullary sites of origin: pancreatic head parenchyma, distal CBD, ampulla of Vater, and second portion of duodenum), the rate of preoperative biliary drainage (percutaneous transhepatic biliary drainage with cases where surgery was delayed at least 2 weeks due to severe obstructive jaundice (serum bilirubin ≥ 250 μmol/L), cholangitis, severe pruritus or other comorbidities, etc. [13,14]).…”

Section: Data Collectionmentioning

confidence: 99%

Pancreaticoduodenectomy with superior mesenteric artery first-approach combined total meso-pancreas excision for periampullary malignancies: A high-volume single-center experience with short-term outcomes

Nguyen,

Luong

et al. 2023

Ann Hepatobiliary Pancreat Surg

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Backgrounds/Aims Pancreaticoduodenectomy (PD) is the only radical treatment for periampullary malignancies. Superior mesenteric artery (SMA) first approach combined with total meso-pancreas (MP) excision was conducted to improve the oncological results. There has not been any previous research of a technique that combines the SMA first approach and total MP excision with a detailed description of the MP macroscopical shape. Methods We prospectively assessed 77 patients with periampullary malignancies between October 2020 and March 2022 (18 months). All patients had undergone PD with SMA first approach combined total MP excision. The perioperative indications, clinical data, intra-operative index, R0 resection rate of postoperative pathological specimens (especially mesopancreatic margin), postoperative complications, and follow-up results were evaluated. Results The median operative time was 289.6 min (178−540 min), the median intraoperative blood loss was 209 mL (30−1,600 mL). Microscopically, there were 19 (24.7%) cases with metastatic MP, and five cases (6.5%) with R1-resection of the MP. The number of lymph nodes (LNs) harvested and metastatic LNs were 27.2 (maximum was 74) and 1.8 (maximum was 16), respectively. Some (46.8%) patients had pancreatic fistula, but mostly in grade A, with 7 patients (9.1%) who required re-operations. Some 18.2% of cases developed postoperative refractory diarrhea. The rate of in-hospital mortality was 1.3%. Conclusions The PD with SMA first approach combined TMpE for periampullary malignancies was effective in achieving superior oncological statistics (rate of MP R0-resection and number of total resected LNs) with non-inferior short-term outcomes. It is necessary to evaluate survival outcomes with long-term follow-up.

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Periampullary Carcinoma for Whipple’s Procedure

Singh

2024

Problem Based Learning Discussions in Onco-Anesthesia and Onco-Critical Care

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

Cited by 7 publications

References 41 publications

The Practice of Pancreatoduodenectomy in India: A Nation-Wide Survey

The Practice of Pancreatoduodenectomy in India: A Nation-Wide Survey

Pancreaticoduodenectomy with superior mesenteric artery first-approach combined total meso-pancreas excision for periampullary malignancies: A high-volume single-center experience with short-term outcomes

Periampullary Carcinoma for Whipple’s Procedure

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