Effect of preoperative biliary decompression on pancreaticoduodenectomy-associated morbidity in 300 consecutive patients
| Autor: | Sandeep Lahoti, Kenneth R. Hess, Jeffrey E. Lee, Douglas B. Evans, Peter W.T. Pisters, Wayne A. Hudec, Jean Nicolas Vauthey, Isaac Raijman |
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| Rok vydání: | 2001 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent medicine.medical_treatment Preoperative care Pancreaticoduodenectomy Pancreatic cancer Preoperative Care medicine Humans Child Aged Aged 80 and over business.industry General surgery Retrospective cohort study Perioperative Original Articles Length of Stay Middle Aged medicine.disease Surgery Pancreatic Neoplasms Clinical research Pancreatectomy Etiology Drainage Female business |
| Zdroj: | Annals of surgery. 234(1) |
| ISSN: | 0003-4932 |
| Popis: | As institutions have acquired significant experience with various complex pancreaticobiliary surgical procedures, 1–3 there has been renewed interest in investigating the risk/benefit ratio for preoperative biliary drainage. 4–9 In contrast to the putative benefits of preoperative biliary drainage that formed the basis for the first generation of controlled trials, 10–15 recent retrospective studies have suggested that the placement of biliary drains and subsequent bacterial colonization of the biliary tree may increase the rates of morbidity 4,8,16 and mortality 4 of pancreaticoduodenectomy. A recent comprehensive report from Memorial Sloan-Kettering Cancer Center of 240 consecutive patients who underwent pancreaticoduodenectomy showed that preoperative biliary drainage was associated with increased perioperative rates of morbidity and mortality. 4 Preoperative biliary drainage was found to be the only statistically significant variable associated with overall complications, infectious complications, intraabdominal abscess, and postoperative death. A four-fold increase in operative mortality rate among patients with stents caused the authors to recommend that preoperative biliary drainage be avoided whenever possible. The authors suggested instead that prompt pancreaticoduodenectomy may improve patient outcome after pancreaticoduodenectomy. These observations may have a significant impact on staging and referral practices for physicians who evaluate patients with obstructive jaundice of presumed malignant extrahepatic etiology. The objective of this study was to examine the potential relationship between preoperative biliary drainage and subsequent morbidity and mortality after pancreaticoduodenectomy performed in a tertiary care cancer center. During the past decade, we have maintained an active clinical research program of multimodality therapy for localized pancreatic cancer. To receive preoperative (neoadjuvant) treatment, patients with obstructive jaundice required biliary decompression. Thus, if a significant relationship between preoperative biliary drainage and surgical morbidity and mortality exists, we should be able to identify the association given the large number of patients who have undergone biliary decompression prior to pre-operative combined-modality therapy and pancreaticoduodenectomy at our institution. |
| Databáze: | OpenAIRE |
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