Clinical impact of preoperative biliary drainage on postoperataive complications in pancreaticoduodenectomy.

Abstract

302 Background: Biliary drainage is sometimes necessary for patients undergoing pancreaticoduodenectomy (PD) because of tumor invasion to the biliary tract. The current study aims to explore the clinical impact of preoperative biliary drainage (PBD) on postoperative complication in PD. Methods: One hundred sixty-six patients who underwent PD from 2012–2017 were enrolled in this study. Clinical impact of PBD on clinical course was examined. Results: There were 66 patients (40%) undergoing PBD. Patients with PBD showed significantly higher infection rate of bile juice collected at surgery (p < 0.0001) and contamination rate of ascites collected from intraperitoneal drain on postoperative day 3 (POD3) (p < 0.0001) than patients without PBD. Severe postoperative complication (Clavien Dindo ≥ IIIB)was associated with contaminated ascites on POD3 (p = 0.031), but not with PBD. Among patients with PBD, fifty-two patients (79%) received preoperative ERBD. Infection of bile juice at surgery was not associated with the procedure of PBD (ERBD, ENBD or PTCD), but correlated with the duration of drainage. Receiver operating characteristic analysis revealed that patients with PBD for more than 28 days occurs contamination of bile juice at surgery. Among patients with both the contaminated bile juice at operation and the contaminated ascites on POD3 (n = 24), both were consistent in 19 patients (79%). Although Enterococcus faecalis was the most species seen in their bile juice, patients with the contamination of other species of Enterobacter (36%) and Streptococcus (2%) showed higher severe postoperative complication rate than others (p = 0.049). Conclusions: PBD was not directly associated with severe postoperative complication, but the duration of drainage for > 28 days was correlated with contamination of the bile juice. Contaminated ascites on POD3 caused by infectious bile juice at surgery was an only factor associated with severe postoperative complications and therefore needs careful management of the drain removal and selection of antibiotics after surgery.