Short-term preoperative drainage is associated with improved postoperative outcomes compared to that of long-term biliary drainage in pancreatic surgery

F Oehme; S Hempel; M Pecqueux; B Müssle; H M Hau; C Teske; F von Bechtolsheim; L Seifert; M Distler; T Welsch; J Weitz; Cristoph Kahlert

doi:10.1007/s00423-021-02402-7

Short-term preoperative drainage is associated with improved postoperative outcomes compared to that of long-term biliary drainage in pancreatic surgery

Langenbecks Arch Surg. 2022 May;407(3):1055-1063. doi: 10.1007/s00423-021-02402-7. Epub 2021 Dec 15.

Authors

F Oehme¹, S Hempel¹, M Pecqueux¹, B Müssle¹, H M Hau¹, C Teske¹, F von Bechtolsheim¹, L Seifert¹, M Distler¹, T Welsch¹, J Weitz¹, Cristoph Kahlert²

Affiliations

¹ Department for Visceral-, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
² Department for Visceral-, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany. Christoph.Kahlert@uniklinikum-dresden.de.

Abstract

Purpose: The treatment of choice for patients presenting with obstructive cholestasis due to periampullary carcinoma is oncologic resection without preoperative biliary drainage (PBD). However, resection without PBD becomes virtually impossible in patients with obstructive cholangitis or severely impaired liver cell function. The appropriate duration of drainage by PBD has not yet been defined for these patients.

Methods: A retrospective analysis was conducted on 170 patients scheduled for pancreatic resection following biliary drainage between January 2012 and June 2018 at the University Hospital Dresden in Germany. All patients were deemed eligible for inclusion, regardless of the underlying disease entity. The primary endpoint analysis was defined as the overall morbidity (according to the Clavien-Dindo classification). Secondary endpoints were the in-hospital mortality and malignancy adjusted overall and recurrence-free survival rates.

Results: A total of 170 patients were included, of which 45 (26.5%) and 125 (73.5%) were assigned to the short-term (< 4 weeks) and long-term (≥ 4 weeks) preoperative drainage groups, respectively. Surgical complications (Clavien-Dindo classification > 2) occurred in 80 (47.1%) patients, with significantly fewer complications observed in the short-term drainage group (31.1% vs. 52%; p = 0.02). We found that long-term preoperative drainage (unadjusted OR, 3.386; 95% CI, 1.507-7.606; p < 0.01) and periampullary carcinoma (unadjusted OR, 5.519; 95% CI, 1.722-17.685; p-value < 0.01) were independent risk factors for postoperative morbidity, based on the results of a multivariate regression model. The adjusted overall and recurrence-free survival did not differ between the groups (p = 0.12).

Conclusion: PBD in patients scheduled for pancreatic surgery is associated with substantial perioperative morbidity. Our results indicate that patients who have undergone PBD should be operated on within 4 weeks after drainage.

Keywords: Complication; Pancreatic cancer; Pancreatic surgery; Preoperative biliary drainage.

MeSH terms

Carcinoma* / surgery
Drainage / methods
Duodenal Neoplasms* / surgery
Humans
Jaundice, Obstructive* / surgery
Pancreatic Neoplasms* / pathology
Pancreaticoduodenectomy / adverse effects
Pancreaticoduodenectomy / methods
Postoperative Complications
Preoperative Care / methods
Retrospective Studies
Treatment Outcome