Dragonframe 3.6 full5/7/2023 ![]() The pancreatic stump was managed with an end-to-side pancreaticojejunostomy (with or without duct stenting). Routinely, a laparotomic cephalic pancreaticoduodenectomy without pyloric preservation and a standard lymph node dissection was the technique used. PBD is sometimes performed in the absence of the previously mentioned indications, which makes it difficult to assess and discuss its real impact on postoperative morbidity and patients’ prognosis.Ī retrospective study was conducted that included 128 consecutive patients who underwent CPD for PDAC, between January 2008 and August 2021 at our department, without neoadjuvant treatment. This procedure is not routinely recommended for patients taken in for surgical resection, as it can increase complications, and formal indications for its use are still debated. Furthermore, it allows for resectable patients to safely wait for surgical resection when it cannot be performed in a short-term period when they develop severe pruritus, severe hyperbilirubinemia, acute cholangitis, or jaundice-related systemic complications. It is the only procedure that allows for non-resectable jaundiced patients to be treated with neoadjuvant therapy, and a biopsy can be performed in the same intervention in order to reach a definitive diagnosis. Preoperative biliary drainage (PBD) aims to restore the normal bile flow. Progressive and prolonged obstructive jaundice leads to fatigue, malnutrition, bile stasis, and endotoxemia, being associated with hepatic dysfunction, coagulopathy, infections, anastomotic leakage, and delayed recovery after surgery. Patients undergoing PTC appear to have an early recurrence.įor PDAC located in the head of the pancreas, jaundice is the most common clinical sign at diagnosis. ERCP seems to contribute to the development of clinically significant DGE. 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. Groups 1.1 and 1.2 had a significant difference in DFS (10 vs. There were no significant differences in median overall survival and disease-free survival (DFS) between groups 1 and 2. Between groups 1.1 and 1.2, there was a significant difference in clinically relevant DGE (44.4% vs. 3.6%, p < 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. There was a significant difference between group 1 and 2 regarding bacterial colonization of the bile (45.5% vs. 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 ( p = 0.074). Group 1 was subdivided according to the drainage route: endoscopic retrograde cholangiopancreatography (ERCP), group 1.1, and percutaneous transhepatic cholangiography (PTC), group 1.2. 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). 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. ![]()
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