The clinical value of preoperative biliary drainage in patients undergoing pancreaticoduodenectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LAI Zeru , RUAN Zikang , CHEN Guoliang ,  CHE Siyao

Department of Hepatobiliary Surgery, Gaozhou People’s Hospital, Guangdong Medical University, Gaozhou, Guangdong 525200, P. R. China;

Corresponding?author：

CHE Siyao, Email: siyaoche01@126.com

Keywords：

jaundice; preoperative biliary drainage; complication; the comprehensive complication index

DOI：

10.7507/1007-9424.201812081

Video：

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Objective To investigate the clinical value of preoperative biliary drainage in patients with malignant obstructive jaundice and its influence on postoperative complications.Methods This study retrospectively analyzed patients from June 2006 to June 2018 at Department of Hepatobiliary Surgery of Gaozhou People’s Hospital, Guangdong Medical University, who had underwent pancreaticoduodenal surgery. In this study, bilirubin was divided into bilirubin normal group and bilirubin abnormal group according to the level of bilirubin, then the bilirubin abnormal group was divided into non-drainage group and drainage group. The main observation indexes were the incidence of complications and their severity.Results There was no difference in intraoperative blood loss, operative time, and postoperative hospitalization among the three groups (P>0.05), but there was significant difference among the three groups on incidence of bile leakage, pulmonary infection, and the comprehensive complication index (CCI) value (P<0.05). The trend of clotting time, serum albumin, and hemoglobin in the bilirubin normal group, non-drainage group, and drainage group after operation were basically the same. The transaminase was recovered after operation in the bilirubin normal group and the drainage group, which were better than that of the non-drainage group within 7 days .Conclusions The preoperative biliary drainage in patients with malignant obstructive jaundice complicated with hyperbilirubinemia, cholangitis, and hepatic dysfunction do not significantly improve the incidence of complications, but could significantly improve the severity of the overall complication.

Citation： LAI Zeru, RUAN Zikang, CHEN Guoliang, CHE Siyao. The clinical value of preoperative biliary drainage in patients undergoing pancreaticoduodenectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(6): 696-701. doi: 10.7507/1007-9424.201812081 Copy

1.	Robinson JR, Marincola P, Shelton J, et al. Peri-operative risk factors for delayed gastric emptying after a pancreaticoduodenectomy. HPB (Oxford), 2015, 17(6): 495-501.
2.	Papadopoulos V, Filippou D, Manolis E, et al. Haemostasis impairment in patients with obstructive jaundice. J Gastrointestin Liver Dis, 2007, 16(2): 177-186.
3.	Hunt DR, Allison ME, Prentice CR, et al. Endotoxemia, disturbance of coagulation, and obstructive jaundice. Am J Surg, 1982, 144(3): 325-329.
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(1): 17-27.
5.	Wang Q, Gurusamy KS, Lin H, et al. Preoperative biliary drainage for obstructive jaundice. Cochrane Database Syst Rev, 2008, (3): CD005444.
6.	Slankamenac K, Graf R, Barkun J, et al. The comprehensive complication index: a novel continuous scale to measure surgical morbidity. Ann Surg, 2013, 258(1): 1-7.
7.	王華, 汪濤, 湯禮軍, 等. 惡性梗阻性黃疸微創引流術式選擇分析. 中國普外基礎與臨床雜志, 2011, 18(10): 1100-1102.
8.	van der Gaag NA, Rauws EA, van Eijck CH, et al. Preoperative biliary drainage for cancer of the head of the pancreas. N Engl J Med, 2010, 362(2): 129-137.
9.	田伏洲, 石力, 湯禮軍, 等. 惡性梗阻性黃疸手術時機探討. 中國實用外科雜志, 2007, 27(10): 802-804.
10.	Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg, 2009, 250(2): 187-196.
11.	Bassi C, Marchegiani G, Dervenis C, 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.
12.	中華醫學會外科學分會胰腺外科學組, 中國研究型醫院學會胰腺病專業委員會, 中華外科雜志編輯部. 胰腺術后外科常見并發癥診治及預防的專家共識(2017). 中華外科雜志, 2017, 55(5): 328-334.
13.	Parks RW, Clements WD, Smye MG, et al. Intestinal barrier dysfunction in clinical and experimental obstructive jaundice and its reversal by internal biliary drainage. Br J Surg, 1996, 83(10): 1345-1349.
14.	Clements WD, McCaigue M, Erwin P, et al. Biliary decompression promotes Kupffer cell recovery in obstructive jaundice. Gut, 1996, 38(6): 925-931.
15.	Hamoud AR, Weaver L, Stec DE, et al. Bilirubin in the liver-gut signaling axis. Trends Endocrinol Metab, 2018, 29(3): 140-150.
16.	吳言濤. 梗阻性黃疸的圍手術期處理. 中國普外基礎與臨床雜志, 2003, 10(3): 183-185.
17.	Lygidakis NJ, van der Heyde MN, Lubbers MJ. Evaluation of preoperative biliary drainage in the surgical management of pancreatic head carcinoma. Acta Chir Scand, 1987, 153(11-12): 665-668.
18.	Povoski SP, Karpeh MS Jr, Conlon KC, et al. Association of preoperative biliary drainage with postoperative outcome following pancreaticoduodenectomy. Ann Surg, 1999, 230(2): 131-142.
19.	Singhirunnusorn J, Roger L, Chopin-Laly X, et al. Value of preoperative biliary drainage in a consecutive series of resectable periampullary lesions. From randomized studies to real medical practice. Langenbecks Arch Surg, 2013, 398(2): 295-302.
20.	Kimmings AN, van Deventer SJ, Obertop H, et al. Endotoxin, cytokines, and endotoxin binding proteins in obstructive jaundice and after preoperative biliary drainage. Gut, 2000, 46(5): 725-731.
21.	van der Gaag NA, Kloek JJ, de Castro SM, et al. Preoperative biliary drainage in patients with obstructive jaundice: history and current status. J Gastrointest Surg, 2009, 13(4): 814-820.
22.	Slankamenac K, Nederlof N, Pessaux P, et al. The comprehensive complication index: a novel and more sensitive endpoint for assessing outcome and reducing sample size in randomized controlled trials. Ann Surg, 2014, 260(5): 757-762.
23.	El Nakeeb A, Salem A, Mahdy Y, et al. Value of preoperative biliary drainage on postoperative outcome after pancreaticoduodenectomy: a case-control study. Asian J Surg, 2018, 41(2): 155-162.
24.	Kim TH, Suh YS, Huh YJ, et al. The comprehensive complication index (CCI) is a more sensitive complication index than the conventional Clavien-Dindo classification in radical gastric cancer surgery. Gastric Cancer, 2018, 21(1): 171-181.
25.	陳東, 梁力建, 彭寶崗, 等. 術前減黃對惡性低位膽道梗阻患者行胰十二指腸切除術前后肝功能變化的影響. 癌癥, 2008, 27(1): 78-82.
26.	劉元進, 張永杰. 梗阻性黃疸行膽道引流前后肝臟的病理生理變化. 肝膽胰外科雜志, 2018, 30(5): 436-440.

1. Robinson JR, Marincola P, Shelton J, et al. Peri-operative risk factors for delayed gastric emptying after a pancreaticoduodenectomy. HPB (Oxford), 2015, 17(6): 495-501.
2. Papadopoulos V, Filippou D, Manolis E, et al. Haemostasis impairment in patients with obstructive jaundice. J Gastrointestin Liver Dis, 2007, 16(2): 177-186.
3. Hunt DR, Allison ME, Prentice CR, et al. Endotoxemia, disturbance of coagulation, and obstructive jaundice. Am J Surg, 1982, 144(3): 325-329.
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(1): 17-27.
5. Wang Q, Gurusamy KS, Lin H, et al. Preoperative biliary drainage for obstructive jaundice. Cochrane Database Syst Rev, 2008, (3): CD005444.
6. Slankamenac K, Graf R, Barkun J, et al. The comprehensive complication index: a novel continuous scale to measure surgical morbidity. Ann Surg, 2013, 258(1): 1-7.
7. 王華, 汪濤, 湯禮軍, 等. 惡性梗阻性黃疸微創引流術式選擇分析. 中國普外基礎與臨床雜志, 2011, 18(10): 1100-1102.
8. van der Gaag NA, Rauws EA, van Eijck CH, et al. Preoperative biliary drainage for cancer of the head of the pancreas. N Engl J Med, 2010, 362(2): 129-137.
9. 田伏洲, 石力, 湯禮軍, 等. 惡性梗阻性黃疸手術時機探討. 中國實用外科雜志, 2007, 27(10): 802-804.
10. Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg, 2009, 250(2): 187-196.
11. Bassi C, Marchegiani G, Dervenis C, 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.
12. 中華醫學會外科學分會胰腺外科學組, 中國研究型醫院學會胰腺病專業委員會, 中華外科雜志編輯部. 胰腺術后外科常見并發癥診治及預防的專家共識(2017). 中華外科雜志, 2017, 55(5): 328-334.
13. Parks RW, Clements WD, Smye MG, et al. Intestinal barrier dysfunction in clinical and experimental obstructive jaundice and its reversal by internal biliary drainage. Br J Surg, 1996, 83(10): 1345-1349.
14. Clements WD, McCaigue M, Erwin P, et al. Biliary decompression promotes Kupffer cell recovery in obstructive jaundice. Gut, 1996, 38(6): 925-931.
15. Hamoud AR, Weaver L, Stec DE, et al. Bilirubin in the liver-gut signaling axis. Trends Endocrinol Metab, 2018, 29(3): 140-150.
16. 吳言濤. 梗阻性黃疸的圍手術期處理. 中國普外基礎與臨床雜志, 2003, 10(3): 183-185.
17. Lygidakis NJ, van der Heyde MN, Lubbers MJ. Evaluation of preoperative biliary drainage in the surgical management of pancreatic head carcinoma. Acta Chir Scand, 1987, 153(11-12): 665-668.
18. Povoski SP, Karpeh MS Jr, Conlon KC, et al. Association of preoperative biliary drainage with postoperative outcome following pancreaticoduodenectomy. Ann Surg, 1999, 230(2): 131-142.
19. Singhirunnusorn J, Roger L, Chopin-Laly X, et al. Value of preoperative biliary drainage in a consecutive series of resectable periampullary lesions. From randomized studies to real medical practice. Langenbecks Arch Surg, 2013, 398(2): 295-302.
20. Kimmings AN, van Deventer SJ, Obertop H, et al. Endotoxin, cytokines, and endotoxin binding proteins in obstructive jaundice and after preoperative biliary drainage. Gut, 2000, 46(5): 725-731.
21. van der Gaag NA, Kloek JJ, de Castro SM, et al. Preoperative biliary drainage in patients with obstructive jaundice: history and current status. J Gastrointest Surg, 2009, 13(4): 814-820.
22. Slankamenac K, Nederlof N, Pessaux P, et al. The comprehensive complication index: a novel and more sensitive endpoint for assessing outcome and reducing sample size in randomized controlled trials. Ann Surg, 2014, 260(5): 757-762.
23. El Nakeeb A, Salem A, Mahdy Y, et al. Value of preoperative biliary drainage on postoperative outcome after pancreaticoduodenectomy: a case-control study. Asian J Surg, 2018, 41(2): 155-162.
24. Kim TH, Suh YS, Huh YJ, et al. The comprehensive complication index (CCI) is a more sensitive complication index than the conventional Clavien-Dindo classification in radical gastric cancer surgery. Gastric Cancer, 2018, 21(1): 171-181.
25. 陳東, 梁力建, 彭寶崗, 等. 術前減黃對惡性低位膽道梗阻患者行胰十二指腸切除術前后肝功能變化的影響. 癌癥, 2008, 27(1): 78-82.
26. 劉元進, 張永杰. 梗阻性黃疸行膽道引流前后肝臟的病理生理變化. 肝膽胰外科雜志, 2018, 30(5): 436-440.

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The clinical value of preoperative biliary drainage in patients undergoing pancreaticoduodenectomy

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