Effects of preoperative drainage on postoperative complications in patients with periampullary tumors
Effects of preoperative drainage on postoperative complications in patients with periampullary tumors
Aim: Preoperative biliary drainage is suggested for patients with jaundice, considering that surgical operations may increasepostoperative complications in the presence of jaundice. The aim of this study was to test the effect of biliary drainage on possibleserious complications, deaths, or period of hospital stay.Material and Methods: Between January 2012 and June 2016, 160 patients with operable and resectable periampullary tumorswho were diagnosed with periampullary tumors underwent pancreaticoduodenectomy (Whipple’s procedure) in Marmara UniversityPendik Training and Research Hospital, Department of General Surgery. The patients’ demographics, accompanying comorbiddiseases, type of biliary drainage, drainage duration, pre- and post-drainage laboratory data, emerging complications and need forre-hospitalization were recorded retrospectively from the accessible files and records.Results: It was observed that out of 158 patients with periampullary tumors, 116 that were operated with drainage had a higheroccurrence of surgical site infections and anastomotic leaks, compared to the 42 patients that were operated without drainage.Similarly, when patient results were classified according to the Clavien-Dindo complication classification, the ratio was againagainst the patients that were operated with drainage. Drainage patients stayed in the hospital for a longer period; however, in termsof pancreatic fistula, re-hospitalization, need for intensive care and relaparotomy ratios, and especially in terms of mortality ratios, adifference between two patient groups was not observed.Conclusion: Investigating the data collected from patients that were operated without drainage, and specifically considering thebilirubin values of the patients who had complications, there was no threshold identified that contributed to a higher likeliness ofcomplications. Consequently, even though there were no results to motivate recommending drainage, it was concluded that applyingdrainage does not create any difference in short-term prognosis, but drainage increases infectious complications.
___
- 1. Tuncer M. Turkish national cancer control plan 2013 - 2018.
vol. 1, Turkish ministry of health, cancer control center 2015.
- 2. Howlader N, Noone A, Krapcho M, et al. SEER cancer
statistics review, 1975-2012, National Cancer Institute.
Bethesda, MD, http://seer.cancer.gov/csr/1975_2012/,
based on November 2014 SEER data submission, posted to
the SEER web site, April 2015. 2015;1-101.
- 3. Noor MT. Role of needle knife assisted ampullary biopsy
in the diagnosis of periampullary carcinoma. World J
Gastrointest Endosc 2011;3:220-4.
- 4. Sewnath ME, Karsten TM, Prins MH, et al. A meta-analysis
on the efficacy of preoperative biliary drainage for tumors
causing obstructive jaundice. Ann Surg 2002;236:17-27.
- 5. Mersin H, Yildirim E, Irkin F, et al. Pancreaticoduodenectomy
experience in a low-volume center for pancreatic resection.
Turkish J Surg 2010;26:18.
- 6. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA
Cancer J Clin 2016;66:7-30.
- 7. van der Gaag N a, Rauws E a J, van Eijck CHJ, et al.
Preoperative biliary drainage for cancer of the head of the
pancreas N Engl J Med 2010;362:129-37.
- 8. Fang Y, Gurusamy KS, Wang Q, et al. Pre-operative biliary
drainage for obstructive jaundice. Cochrane Database Syst
Rev 2018;12:CD005444.
- 9. Chen Y, Ou G, Lian G, et al. Effect of preoperative biliary drainage
on complications following pancreatoduodenectomy: a
meta-analysis. Medicine (Baltimore) 2015;94:e1199.
- 10. Martignoni ME, Wagner M, Krähenbühl L, et al. Effect of
preoperative biliary drainage on surgical outcome after
pancreatoduodenectomy. Am J Surg 2001;181:52-9.
- 11. Wang C, Xu Y, Lu X. Should preoperative biliary drainage be
routinely performed for obstructive jaundice with resectable
tumor ? Hepatobiliary Surg Nutr 2013;2:266-71.
- 12. Lang E, Gatidis S, Freise NF, et al. Conjugated bilirubin
triggers anemia by inducing erythrocyte death. Hepatology
2015;61:275-84.
- 13. Pisters PW, Hudec W a, Hess KR, et al. Effect of preoperative
biliary decompression on pancreaticoduodenectomyassociated
morbidity in 300 consecutive patients. Ann Surg
2001;234:47-55.
- 14. Kagedan DJ, Ahmed M, Devitt KS, et al. Enhanced recovery
after pancreatic surgery: A systematic review of the
evidence. Hpb 2015;17:11-6.
- 15. Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-
Dindo classification of surgical complications: five-year
experience. Ann Surg 2009;250:187-96.
- 16. Seetharam P, Rodrigues GS. Postoperative pancreatic
fistula: A surgeon’s nightmare! an insight with a detailed
literature review. J Pancreas 2015;16:115-24.
- 17. Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula: an international study group (ISGPF)
definition. Surgery 2005;138:8-13.
- 18. Wente MN, Bassi C, Dervenis C, et al. Delayed gastric
emptying (DGE) after pancreatic surgery : a suggested
definition by the international study Group of pancreatic
surgery. Surgery 2007;142:761-8.
- 19. Winter JM, Cameron JL, Campbell KA, et al. 1423
Pancreaticoduodenectomies for Pancreatic Cancer:
A Single-Institution Experience. J Gastrointest Surg
2006;10:1199-211.
- 20. Diener MK, JF Fitzmaurice C, Schwarzer G, et al. Pyloruspreserving
pancreaticoduodenectomy (pp Whipple) versus
pancreaticoduodenectomy (classic Whipple) for surgical
treatment of periampullary and pancreatic carcinoma.
Cochrane Database Syst Rev 2011;11: CD006053.
- 21. Huang X, Liang B, Zhao X-Q, et al. The effects of different
preoperative biliary drainage methods on complications
following pancreaticoduodenectomy. Medicine (Baltimore)
2015;94:e723.
- 22. Sun C, Yan G, Li Z, et al. A meta-analysis of the effect of
preoperative biliary stenting on patients with obstructive
jaundice. Medicine (Baltimore) 2014;93:e189.
- 23. McMillan MT, Soi S, Asbun HJ, et al. Risk-adjusted
Outcomes of Clinically Relevant Pancreatic Fistula Following
Pancreatoduodenectomy: A Model for Performance
Evaluation. Ann Surg 2016;264:344-52.
- 24. Nakeeb A El, Atef E, El Hanafy E, et al. Outcomes of
pancreaticoduodenectomy in elderly patients. Hepatobiliary
Pancreat Dis Int 2016;15:419-27.
- 25. Moole H, Bechtold M, Puli SR. Efficacy of preoperative biliary
drainage in malignant obstructive jaundice: a meta-analysis
and systematic review. World J Surg Oncol 2016;14:182.