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

Background The present study aimed to determine the optimal timing of pancreaticoduodenectomy (PD) following preoperative biliary drainage (PBD) with consideration of postoperative morbidity and survival. Methods Between January 2007 and December 2015, consecutive 1,568 patients underwent PD at a single institution. Their data were reviewed retrospectively. Results Of all, 831 patients underwent PBD. The mean duration between drainage and surgery was 16.9 days. Regarding postoperative outcomes, length of hospital stay was longer in the drainage group (P = 0.028). Postoperative pancreatic fistula was not significantly different between the non-drainage and drainage groups (P = 0.162), but major complications occurred more frequently in the drainage group (P = 0.002). Multivariable analysis showed major complications occurred significantly at third and fourth weeks (odds ratios 1.863 and 2.523) after PBD, whereas early surgery performed in the first 2 weeks did not noticeably increase postoperative complications. In multivariable survival comparison, weekly interval beyond 6 weeks was associated with poor survival in those with pancreatic cancer, while patients with bile duct cancer operated on at the fourth week showed worse prognosis. Conclusions Early surgery that reduces the operative delay after PBD may improve both short- and long-term postoperative outcomes in cancer patients undergoing PBD.