Optimal timing of pancreaticoduodenectomy following preoperative biliary drainage considering major morbidity and postoperative survival

Abstract

Introduction: The present study aims to assess the impact of preoperative biliary drainage (PBD) on postoperative outcomes and to investigate optimal timing of pancreaticoduodenectomy (PD) following PBD in terms of postoperative morbidity and survival. Method: Between January 2007 and December 2015, consecutive 1568 patients underwent PD at a single institute. Clinicopathological and survival data were reviewed retrospectively. Result: Of all, 831 patients underwent PBD. Mean duration between drainage and surgery was 16.9 days. When the duration was subdivided weekly, 196 underwent PD in 1st week, 300 in 2nd week, 170 in 3rd week, 91 in 4th week, 27 in 5th week and 47 beyond 6th week. In postoperative outcomes, length of stay was longer in drainage group (p=0.028). Postoperative pancreatic fistula was not significantly different between non-drainage and drainage groups (p=0.162), but major complications occurred significantly more in drainage group (p=0.002). Multivariable analysis showed major complications occurred significantly in weekly interval 3 and 4 weeks (odds ratios, 1.863 and 2.523), whereas early (1 to 2 weeks) or late (beyond 4weeks) periods were not associated with complications. In multivariable survival comparison, weekly interval beyond 6 weeks was associated with poor survival in pancreatic cancer, and 4 weeks interval showed worse prognosis in bile duct cancer. Conclusion: Considering the long-term survival of cancer patients, early surgery that reduces the operative delay after PBD may enhance postoperative outcomes if preoperative biliary infection is recovered through biliary drainage.