Clinical Impact of Preoperative Biliary Drainage in Patients with Ductal Adenocarcinoma of the Pancreatic Head
Our aim was to study the association between preoperative biliary drainage (PBD) and morbidity following cephalic pancreaticoduodenectomy (CPD) for pancreatic ductal adenocarcinoma (PDAC) and its prognostic impact, which is still controversial in the literature. A retrospective study was conducted,...
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MDPI AG
2023-03-01
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| Series: | Diagnostics |
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| Online Access: | https://www.mdpi.com/2075-4418/13/7/1281 |
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| author | Maria João Amaral João Freitas Mariana Amaral Marco Serôdio Rui Caetano Oliveira Paulo Donato José Guilherme Tralhão |
| author_facet | Maria João Amaral João Freitas Mariana Amaral Marco Serôdio Rui Caetano Oliveira Paulo Donato José Guilherme Tralhão |
| author_sort | Maria João Amaral |
| collection | DOAJ |
| description | Our aim was to study the association between preoperative biliary drainage (PBD) and morbidity following cephalic pancreaticoduodenectomy (CPD) for pancreatic ductal adenocarcinoma (PDAC) and its prognostic impact, which is still controversial in the literature. A retrospective study was conducted, which included 128 patients who underwent CPD for PDAC, divided into two groups: those who underwent PBD (group 1) and those who did not undergo this procedure (group 2). Group 1 was subdivided according to the drainage route: endoscopic retrograde cholangiopancreatography (ERCP), group 1.1, and percutaneous transhepatic cholangiography (PTC), group 1.2. 34.4% of patients underwent PBD, and 47.7% developed PBD-related complications, with 37% in group 1.1 and 64.7% in group 1.2 (<i>p</i> = 0.074). There was a significant difference between group 1 and 2 regarding bacterial colonization of the bile (45.5% vs. 3.6%, <i>p</i> < 0.001), but no difference was found in the colonization by multidrug-resistant bacteria, the development of Clavien–Dindo ≥ III complications, clinically relevant pancreatic fistula and delayed gastric emptying (DGE), intra-abdominal abscess, hemorrhage, superficial surgical site infection (SSI), and readmission. Between groups 1.1 and 1.2, there was a significant difference in clinically relevant DGE (44.4% vs. 5.9%, <i>p</i> = 0.014) and Clavien–Dindo ≥ III complications (59.3% vs. 88.2%, <i>p</i> = 0.040). There were no significant differences in median overall survival and disease-free survival (DFS) between groups 1 and 2. Groups 1.1 and 1.2 had a significant difference in DFS (10 vs. 5 months, <i>p</i> = 0.017). In this group of patients, PBD was associated with increased bacterial colonization of the bile, without a significant increase in postoperative complications or influence in survival. ERCP seems to contribute to the development of clinically significant DGE. Patients undergoing PTC appear to have an early recurrence. |
| first_indexed | 2024-03-11T05:40:21Z |
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| institution | Directory Open Access Journal |
| issn | 2075-4418 |
| language | English |
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| spelling | doaj.art-f77bb7b0e2174ed3b164c85c4d7287762023-11-17T16:30:25ZengMDPI AGDiagnostics2075-44182023-03-01137128110.3390/diagnostics13071281Clinical Impact of Preoperative Biliary Drainage in Patients with Ductal Adenocarcinoma of the Pancreatic HeadMaria João Amaral0João Freitas1Mariana Amaral2Marco Serôdio3Rui Caetano Oliveira4Paulo Donato5José Guilherme Tralhão6General Surgey Department, Centro Hospitalar e Universitário de Coimbra, 3000-075 Coimbra, PortugalFaculty of Medicine, University of Coimbra, 3000-548 Coimbra, PortugalFaculty of Medicine, University of Coimbra, 3000-548 Coimbra, PortugalGeneral Surgey Department, Centro Hospitalar e Universitário de Coimbra, 3000-075 Coimbra, PortugalPathology Department, Centro Hospitalar e Universitário de Coimbra, 3000-075 Coimbra, PortugalFaculty of Medicine, University of Coimbra, 3000-548 Coimbra, PortugalGeneral Surgey Department, Centro Hospitalar e Universitário de Coimbra, 3000-075 Coimbra, PortugalOur aim was to study the association between preoperative biliary drainage (PBD) and morbidity following cephalic pancreaticoduodenectomy (CPD) for pancreatic ductal adenocarcinoma (PDAC) and its prognostic impact, which is still controversial in the literature. A retrospective study was conducted, which included 128 patients who underwent CPD for PDAC, divided into two groups: those who underwent PBD (group 1) and those who did not undergo this procedure (group 2). Group 1 was subdivided according to the drainage route: endoscopic retrograde cholangiopancreatography (ERCP), group 1.1, and percutaneous transhepatic cholangiography (PTC), group 1.2. 34.4% of patients underwent PBD, and 47.7% developed PBD-related complications, with 37% in group 1.1 and 64.7% in group 1.2 (<i>p</i> = 0.074). There was a significant difference between group 1 and 2 regarding bacterial colonization of the bile (45.5% vs. 3.6%, <i>p</i> < 0.001), but no difference was found in the colonization by multidrug-resistant bacteria, the development of Clavien–Dindo ≥ III complications, clinically relevant pancreatic fistula and delayed gastric emptying (DGE), intra-abdominal abscess, hemorrhage, superficial surgical site infection (SSI), and readmission. Between groups 1.1 and 1.2, there was a significant difference in clinically relevant DGE (44.4% vs. 5.9%, <i>p</i> = 0.014) and Clavien–Dindo ≥ III complications (59.3% vs. 88.2%, <i>p</i> = 0.040). There were no significant differences in median overall survival and disease-free survival (DFS) between groups 1 and 2. Groups 1.1 and 1.2 had a significant difference in DFS (10 vs. 5 months, <i>p</i> = 0.017). In this group of patients, PBD was associated with increased bacterial colonization of the bile, without a significant increase in postoperative complications or influence in survival. ERCP seems to contribute to the development of clinically significant DGE. Patients undergoing PTC appear to have an early recurrence.https://www.mdpi.com/2075-4418/13/7/1281pancreatic cancerpancreaticoduodenectomyobstructive jaundicebiliary drainageprognosis |
| spellingShingle | Maria João Amaral João Freitas Mariana Amaral Marco Serôdio Rui Caetano Oliveira Paulo Donato José Guilherme Tralhão Clinical Impact of Preoperative Biliary Drainage in Patients with Ductal Adenocarcinoma of the Pancreatic Head Diagnostics pancreatic cancer pancreaticoduodenectomy obstructive jaundice biliary drainage prognosis |
| title | Clinical Impact of Preoperative Biliary Drainage in Patients with Ductal Adenocarcinoma of the Pancreatic Head |
| title_full | Clinical Impact of Preoperative Biliary Drainage in Patients with Ductal Adenocarcinoma of the Pancreatic Head |
| title_fullStr | Clinical Impact of Preoperative Biliary Drainage in Patients with Ductal Adenocarcinoma of the Pancreatic Head |
| title_full_unstemmed | Clinical Impact of Preoperative Biliary Drainage in Patients with Ductal Adenocarcinoma of the Pancreatic Head |
| title_short | Clinical Impact of Preoperative Biliary Drainage in Patients with Ductal Adenocarcinoma of the Pancreatic Head |
| title_sort | clinical impact of preoperative biliary drainage in patients with ductal adenocarcinoma of the pancreatic head |
| topic | pancreatic cancer pancreaticoduodenectomy obstructive jaundice biliary drainage prognosis |
| url | https://www.mdpi.com/2075-4418/13/7/1281 |
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