80 Has the global pandemic health and social situation affected the management of obstructive jaundice secondary to tumuor pathology? A review of our experience in two years of the pandemic

Abstract

Abstract Objectives SARS-CoV-2(COVID19) infection forced a redistribution of hospital resources, including reduction and delay of scheduled surgical activity. We analysed the management of obstructive jaundice (OJ) in patients with potentially resectable periampullary pathology in a tertiary care centre during the pandemic. Methods Observational, single-centre, retrospective study, during the years 2020-2021. The main inclusion criterion was the indication for cephalic duodenopancreatectomy. Patients with criteria of unresectability or indication for neoadjuvant treatment were excluded. We analysed OJ drainage techniques (endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic biliary drainage (PTCD) as well as associated complications. Indications for drainage were: bilirubin >10 mg/dl, cholangitis or expected surgery >2 weeks after inclusion on the waiting list. Results We analysed 75 patients (53.3% male) with an age range of 28-80 years. 59% of patients required drainage by OJ, ERCP was performed in 23 cases and PTCD in 21 cases. Twenty-three stents were placed, 52.1% of which were metal-covered. The most frequent complications associated with ERCP (43.4%) were cholangitis and pancreatitis. The most frequent complication associated with PTCD (28.5%) was cholangitis. Conclusion The correct management of OJ secondary to resectable periampullary tumours is early surgery without preoperative drainage. In case drainage is necessary, the endoscopic approach with placement of a metallic stent seems to be the most indicated. In our series, the COVID19 pandemic led to more preoperative biliary drainage due to longer delays in surgical scheduling, as well as more PTCD approaches due to greater accessibility, this technique also being valid.