Impact of preoperative biliary drainage on postoperative outcome after pancreaticoduodenectomy: An analysis of 1500 consecutive cases

被引:69
|
作者
De Pastena, Matteo [1 ]
Marchegiani, Giovanni [1 ]
Paiella, Salvatore [1 ]
Malleo, Giuseppe [1 ]
Ciprani, Debora [1 ]
Gasparini, Clizia [1 ]
Secchettin, Erica [1 ]
Salvia, Roberto [1 ]
Gabbrielli, Armando [2 ]
Bassi, Claudio [1 ]
机构
[1] Univ Verona, Pancreas Inst, Gen & Pancreat Surg Dept, Verona, Italy
[2] Univ Verona, Pancreas Inst, Gastroenterol & Digest Endoscopy Unit, Verona, Italy
关键词
biliary stent; bilirubin cut-off; infectious complication; jaundice; Whipple procedure; INTERNATIONAL STUDY-GROUP; OBSTRUCTIVE-JAUNDICE; PANCREATIC SURGERY; COMPLICATIONS; DEFINITION; STENTS; METAANALYSIS; MORBIDITY; CANCER; METAL;
D O I
10.1111/den.13221
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background and Aim Implications of preoperative biliary drain on morbidity and mortality after pancreatoduodenectomy are still controversial. The present study aims to assess the impact of preoperative biliary drain on postoperative outcome and to define optimal serum bilirubin cut-off to recommend biliary drainage in patients undergoing pancreatoduodenectomy. Methods All consecutive pancreatoduodenectomies carried out at Verona Hospital from 2005 to 2016 were retrospectively analyzed. The study population was divided into three groups: preoperative biliary drained (Stented Group), preoperative jaundice without drainage (Jaundiced Group) and the control group of non-jaundiced, non-stented patients (Control Group). Results A total of 1500 patients were included. Seven hundred and fourteen patients (47.6%) received biliary drain (stented group), 258 (17.2%) patients did not (jaundiced group) and 528 (35.2%) patients represented the (control group). Major complications and mortality rates did not differ between groups. Conversely, the risk of developing surgical site infections doubled in the stented group (18.1%) (OR = 2.1, 95% CI = 1.5-2.8). In jaundiced patients, a preoperative bilirubin value greater than 7.5 mg/dL (128 mu mol/L) accurately predicted the likelihood of postoperative complications. Conclusion Preoperative biliary drain does not increase major complications and mortality rates after pancreatoduodenectomy, but it is associated with higher surgical site infection rates. In jaundiced patients, a bilirubin value greater than 7.5 mg/dL (128 mu mol/L) should indicate biliary drainage.
引用
收藏
页码:777 / 784
页数:8
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