Impact of Percutaneous Transhepatic Biliary Drainage on Clinical Outcomes of Patients with Malignant Obstructive Jaundice Undergoing Laparoscopic Pancreaticoduodenectomy

Abstract

Preoperative biliary drainage may increase the morbidity and mortality of pancreaticoduodenectomy. Studies on percutaneous transhepatic biliary drainage (PTBD) before laparoscopic pancreaticoduodenectomy (LPD), however, are scarce. The aim of this study was to examine the impact of PTBD on clinical outcomes of patients with malignant obstructive jaundice undergoing LPD. Clinical data of 172 patients who had malignant obstructive jaundice and underwent LPD from 2014 to 2017 in our hospital were retrospectively analyzed. Demographics, catheter-related complications, postoperative complications, and oncological outcomes were collected and analyzed. Propensity score matching was performed to minimize selection bias associated with the comparison of data between patients who underwent PTBD and then LPD (PTBD group), and those given LPD alone (LPD group). The results showed that, in the PTBD group relative to the LPD group, the operating time was significantly shortened (250.28±69.95 vs. 278.58±86.51 min, P=0.0196), the intraoperative blood loss was markedly reduced (271.96±403.47 vs. 429.72±482.47 mL, P=0.022), and overall rates of complications (16.33% vs. 36.49%, P=0.0025) including postoperative haemorrhage (2.04% vs. 12.16%, P=0.0072) and delayed gastric emptying (4.08% vs. 13.51%, P=0.0251) were greatly decreased. The propensity score-matched analysis, with 48 patients enrolled in each group, revealed no statistically significant differences in operating duration (262.71±68.64 vs. 280.25±83.52 min, P=0.264), intraoperative blood loss (290.21±407.71 vs. 373.75±422.33 mL, P=0.327) and delayed gastric emptying (4.17% vs. 12.50%, P=0.1396). PTBD group had lower incidences in overall complications (22.92% vs. 39.58%, P=0.0481) and postoperative haemorrhage (2.08% vs. 12.50%, P=0.0497) than LPD group. In conclusion, patients with malignant obstructive jaundice may benefit from PTBD procedure before LPD in terms of perioperative outcomes.

Keywords

percutaneous transhepatic biliary drainage / laparoscopic pancreaticoduodenectomy / jaundice / complication / propensity score matching

References

[1] PanicciaA, SchulickRD, EdilBH. Total Laparoscopic Pancreaticoduodenectomy: A Single-Institutional Experience. Ann Surg Oncol, 2015, 22(13): 4380-4381

[2] CroomeKP, FarnellMB, QueFG, et al.. Total laparoscopic pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: oncologic advantages over open approaches?. Ann Surg, 2014, 260(4): 633-638 discussion 8–40

[3] SaxenaP, KumbhariV, ZeinME, et al.. Preoperative biliary drainage. Dig Endosc, 2015, 27(2): 265-277

[4] StrasbergSM, GaoF, SanfordD, et al.. Jaundice: an important, poorly recognized risk factor for diminished survival in patients with adenocarcinoma of the head of the pancreas. HPB (Oxford), 2014, 16(2): 150-156

[5] PapadopoulosV, FilippouD, ManolisE, et al.. Haemostasis impairment in patients with obstructive jaundice. J Gastrointestin Liver Dis, 2007, 16(2): 177-186

[6] van der GaagNA, KloekJJ, de CastroSMM, et al.. Preoperative biliary drainage in patients with obstructive jaundice: history and current status. J Gastrointest Surg, 2009, 13(4): 814-820

[7] MooleH, BechtoldM, PuliSR. Efficacy of preoperative biliary drainage in malignant obstructive jaundice: a meta-analysis and systematic review. World J Surg Oncol, 2016, 14(1): 182

[8] FangY, GurusamyKS, WangQ, et al.. Meta-analysis of randomized clinical trials on safety and efficacy of biliary drainage before surgery for obstructive jaundice. Br J Surg, 2013, 100(12): 1589-1596

[9] van der GaagNA, RauwsEAJ, van EijckCHJ, et al.. Preoperative biliary drainage for cancer of the head of the pancreas. N Engl J Med, 2010, 362(2): 129-137

[10] FurukawaK, ShibaH, ShiraiY, et al.. Negative Impact of Preoperative Endoscopic Biliary Drainage on Prognosis of Pancreatic Ductal Adenocarcinoma after Pancreaticoduodenectomy. Anticancer Res, 2015, 35(9): 5079-5083

[11] EshuisWJ, van der GaagNA, RauwsEAJ, et al.. Therapeutic delay and survival after surgery for cancer of the pancreatic head with or without preoperative biliary drainage. Ann Surg, 2010, 252(5): 840-849

[12] ParkSY, ParkCH, ChoSB, et al.. What is appropriate procedure for preoperative biliary drainage in patients with obstructive jaundice awaiting pancreaticoduodenectomy?. Surg Laparosc Endosc Percutan Tech, 2011, 21(5): 344-348

[13] WangM, XuS, ZhangH, et al.. Imbedding pancreaticojejunostomy used in pure laparoscopic pancreaticoduodenectomy for nondilated pancreatic duct. Surg Endosc, 2017, 31(4): 1986-1992

[14] BassiC, MarchegianiG, DervenisC, et al.. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After. Surgery, 2017, 161(3): 584-591

[15] WenteMN, BassiC, DervenisC, et al.. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery, 2007, 142(5): 761-768

[16] AdamMA, ThomasS, YoungwirthL, et al.. Defining a Hospital Volume Threshold for Minimally Invasive Pancreaticoduodenectomy in the United States. JAMA Surg, 2017, 152(4): 336-342

[17] de RooijT, LuMZ, SteenMW, et al.. Minimally Invasive Versus Open Pancreatoduodenectomy: Systematic Review and Meta-analysis of Comparative Cohort and Registry Studies. Ann Surg, 2016, 264(2): 257-267

[18] NehézL, AnderssonR. Compromise of immune function in obstructive jaundice. Eur J Surg, 2002, 168(6): 315-328

[19] SmithRA, DajaniK, DoddS, et al.. Preoperative resolution ofjaundice following biliary stenting predicts more favourable early survival in resected pancreatic ductal adenocarcinoma. Ann Surg Oncol, 2008, 15(11): 3138-3146

[20] GarceaG, CheeW, OngSL, et al.. Preoperative biliary drainage for distal obstruction: the case against revisited. Pancreas, 2010, 39(2): 119-126

[21] FerreroA, Lo TesoriereR, ViganòL, et al.. Preoperative biliary drainage increases infectious complications after hepatectomy for proximal bile duct tumor obstruction. World J Surg, 2009, 33(2): 318-325

[22] KoyamaK, TakagiY, ItoK, et al.. Experimental and clinical studies on the effect of biliary drainage in obstructive jaundice. Am J Surg, 1981, 142(2): 293-299