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Abstract
BackgroundThe efficacy of preoperative biliary drainage (PBD) has been debated for several decades, and yet indications for PBD remain controversial. The aim of this study was to compare the postoperative morbidity and mortality in patients with malignant obstructive jaundice undergoing direct surgery versus surgery with PBD.MethodsAll consecutive patients with malignant obstructive jaundice who underwent radical resection between June 2017 and December 2019 at Zhongshan Hospital were analyzed retrospectively. The study population was divided into two groups: PBD group (PG) and direct surgery group (DG). The subgroups were chosen based on the site of obstruction. Perioperative indicators and postoperative complications were compared and analyzed.ResultsA total of 290 patients were analyzed. Postoperative complications occurred in 134 patients (46.4%). Patients in the PG group had a lower overall rate of postoperative complications compared with the DG group, with perioperative total bilirubin (TB) identified as an independent risk factor in multivariate analysis (hazard ratio = 1.004; 95% confidence interval 1.001–1.007; P = 0.017). Subgroup analysis showed that PBD reduced the complication rate in patients with proximal obstruction. In the proximal-obstruction subgroup, a preoperative TB level > 162 μmol/L predicted postoperative complications.ConclusionsPBD may reduce the overall rate of postoperative complications among patients with proximal malignant obstructive jaundice.Trial registrationClinicalTrials.gov, 2018ZSLC 24. Registered May 17, 2018, https://clinicaltrials.gov/.
Highlights
Biliary obstruction is commonly the first presentation in several cancers affecting the region from the perihilar bile duct to the pancreatic head, including perihilar cholangiocarcinoma, distal cholangiocarcinoma, ampullary carcinoma, and pancreatic ductal adenocarcinoma (PDAC) [1, 2]
A total of 290 consecutive patients with malignant obstructive jaundice who underwent a radical resection at Zhongshan Hospital between June 2017 and December 2019 were included in the study
In PBD group (PG), for 5 (3.1%), and 149 (93.7%) patients, endoscopic biliary stenting (EBS), endoscopic nasobiliary drainage (ENBD), and percutaneous transhepatic biliary drainage (PTBD) were chosen as the initial preoperative biliary drainage (PBD), respectively
Summary
Biliary obstruction is commonly the first presentation in several cancers affecting the region from the perihilar bile duct to the pancreatic head, including perihilar cholangiocarcinoma (pCCA), distal cholangiocarcinoma (dCCA), ampullary carcinoma, and pancreatic ductal adenocarcinoma (PDAC) [1, 2]. Gao et al World Journal of Surgical Oncology (2022) 20:7 intrahepatic cholangiocarcinoma (iCCA), gallbladder carcinoma (GBC), or other tumors invading the extrahepatic bile duct may present with biliary obstruction as the first symptom [3,4,5]. These types of tumors are distinct in their presentation, natural history, and approach to diagnosis and management [6]. PBD is an invasive treatment and carries a risk of procedurerelated complications It has theoretical value, routine PBD does not improve perioperative outcomes in patients with jaundice.
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