Preoperative Biliary Drainage Does Not Independently Reduce Survival After Pancreaticoduodenectomy Among Patients With Pancreatic Ductal Adenocarcinoma: A National Registry Study

Karin Johansen; Kaveh Khodakaram; Linda Lundgren; Kristina Hasselgren; Thomas Gasslander; Per Sandström; Svein Olav Bratlie; Bergthor Björnsson

doi:10.1097/AS9.0000000000000090

Preoperative Biliary Drainage Does Not Independently Reduce Survival After Pancreaticoduodenectomy Among Patients With Pancreatic Ductal Adenocarcinoma: A National Registry Study

Ann Surg Open. 2021 Aug 13;2(3):e090. doi: 10.1097/AS9.0000000000000090. eCollection 2021 Sep.

Authors

Karin Johansen^{1

2}, Kaveh Khodakaram³, Linda Lundgren^{1

2}, Kristina Hasselgren^{1

2}, Thomas Gasslander^{1

2}, Per Sandström^{1

2}, Svein Olav Bratlie³, Bergthor Björnsson^{1

2}

Affiliations

¹ From the Department of Surgery, Linköping University, Linköping, Sweden.
² Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
³ Department of Gastrosurgical Research, Sahlgrenska University Hospital, Gothenburg, Sweden.

Abstract

Objective: This study aimed to explore a possible relationship between preoperative biliary drainage (PBD) and overall survival in a national cohort of Swedish patients who underwent pancreaticoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC).

Background: PBD has been shown to increase postoperative complications after PD, but its use is steadily increasing. There are a few small studies that have indicated that PBD might in itself negatively affect overall survival after PD.

Methods: Patients from the Swedish National Registry for tumors in the pancreatic and periampullary region diagnosed from 2010 to 2019 who underwent PD for PDAC were included. Kaplan-Meier curves, log-rank tests and Cox proportional hazards analyses were performed to investigate survival.

Results: Out of 15,818 patients in the registry, 3113 had undergone PD, of whom 1471 had a histopathological diagnosis of PDAC. Patients who had undergone PBD had significantly worse survival, but the effect of PBD disappeared in the multivariable analysis when elevated bilirubin at any time was included.

Conclusions: PBD does not independently influence survival after PD for PDAC, but this study implies that even a nominally increased preoperative bilirubin level might impair long-term survival.

Keywords: pancreatic cancer; pancreatic ductal adenocarcinoma; pancreaticoduodenectomy; preoperative biliary drainage; survival.