Analysis of curative effect for different preoperative biliary drainage methods in patients undergoing pancreaticoduodenectomy with low malignant obstructive jaundice_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LIU Hao ^1,2 , WU Changwei ³ , REN Likun ⁴ , LI Xingzhi ¹ , XIA Shaoxuan ¹ , LI Jialin ¹ ,  HAN Min ^1,2

1. Department of Hepatobiliary Surgery, Affiliated Hospital of Guizhou Medical University, Guiyang 550001, P. R. China;
2. Clinical Medical College of Guizhou Medical University, Guiyang 550001, P. R. China;
3. Department of Hepatobiliary Surgery, The First People’s Hospital of Bijie City, Bijie, Guizhou 551700, P. R. China;
4. Department of General Surgery, The Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang 550001, P. R. China;

Corresponding?author：

HAN Min, Email: 409582096@qq.com

Keywords：

low malignant obstructive jaundice; preoperative biliary drainage; pancreaticoduodenectomy; complication; prognosis

DOI：

10.7507/1007-9424.202109074

Video：

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Objective To investigate the efficacy of different methods of reducing jaundice in patients with low malignant obstructive jaundice undergoing pancreaticoduodenectomy. Methods A retrospective analysis was performed on the clinicopathological data of patients admitted to the Department of Hepatobiliary Surgery of The Affiliated Hospital of Guizhou Medical University from January 2014 to June 2020 who were considered to have low malignant obstructive jaundice before operation and confirmed by postoperative pathological examination as pancreatic cancer, ampulla cancer, duodenal cancer or carcinoma of the lower segment of the common bile duct. Patients were devide into percutaneous transhepatic cholangial drainage (PTCD) group and endoscopic retrograde biliary drainage (ERBD) group according to preoperative biliary drainage (PBD) methods. In order to reduce selection bias, SPSS propensity matching module was used for propensity score matching analysis. The age, basic diseases (hypertension, diabetes), biochemical indexes, time of reduction of jaundice, total hospitalization time, and postoperative complications of PBD and pancreaticoduodenectomy were compared between the 2 groups. Then, the patients were divided into pancreatic cancer group and non-pancreatic cancer group (including ampulla cancer, duodenal carcinoma and lower common bile duct carcinoma) by tumor type, and compared the effect of two groups of patients receiving different PBD methods. Results A total of 84 patients, 43 males and 41 females, were included in this study, 58 (69.0%) patients with PTCD and 26 (31.0%) patients with ERBD. After PBD the serum total bilirubin, direct bilirubin, γ-glutamyl transferase, and alkaline phosphatase of the PTCD and the ERBD groups patients were lower than before PBD, the differences were statistically significant (P<0.05). Alanine aminotransferase did not change significantly before and after PBD with PTCD (P>0.05), but decreased significantly after PBD with ERBD (P<0.05). Aspartate aminotransferase did not change significantly before and after PBD with ERBD (P>0.05), but decreased significantly after PBD with PTCD(P<0.05). The PBD time and total hospitalization time of the ERBD group were shorter than those of the PTCD group, the differences were statistically significant (P<0.05). The incidences of PBD related complications (cholangitis and pancreatitis) in the ERBD group were higher than those the PTCD group, and the incidence of bleeding in the ERBD group was lower than that the PTCD group, but the differences were not statistically significant (P>0.05). In the patients with pancreatic cancer group, the PBD time by ERBD was shorter than that of the receiving PTCD, the difference was statistically significant (P=0.006). In the non-pancreatic cancer group, the total hospitalization time and PBD time of patients receiving ERBD were shorter than those receiving PTCD, and the differences were statistically significant (P<0.05). In all patients, the median survival time of PTCD group (14 months) was shorter than that in ERBD group (18 months), P=0.002; pancreatic cancer group (12 months) was shorter than non-pancreatic cancer group (16 months), P=0.034; in non-pancreatic cancer group, ERBD group (20 months) was longer than PTCD group (15 months), P=0.008. Conclusions ERBD can shorten the waiting time of operation and hospital stay as compared with PTCD, and has a longer median survival time. It can be used as the first choice for PBD in patients with low malignant obstructive jaundice.

Citation： LIU Hao, WU Changwei, REN Likun, LI Xingzhi, XIA Shaoxuan, LI Jialin, HAN Min. Analysis of curative effect for different preoperative biliary drainage methods in patients undergoing pancreaticoduodenectomy with low malignant obstructive jaundice. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(7): 919-926. doi: 10.7507/1007-9424.202109074 Copy

1.	王雷, 張向化, 伍路, 等. PTCD與ENBD對惡性梗阻性黃疸術前減黃效果的臨床比較. 肝膽胰外科雜志, 2019, 31(5): 310-313.
2.	潘孜博, 王宇宏, 孔哲, 等. 低位惡性梗阻性黃疸術前膽道引流方式的選擇. 中華肝膽外科雜志, 2020, 26(4): 259-264.
3.	Fang Y, Gurusamy KS, Wang Q, 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.
4.	Shen Z, Zhang J, Zhao S, et al. Preoperative biliary drainage of severely obstructive jaundiced patients decreases overall postoperative complications after pancreaticoduodenectomy: a retrospective and propensity score-matched nalysis. Pancreatology, 2020, 20(3): 529-536.
5.	邢穎, 張洪義. 惡性梗阻性黃疸術前減黃的方式及必要性探討. 中國醫刊, 2019, 37(7): 704-707.
6.	Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6 336 patients and results of a survey. Ann Surg, 2004, 240(2): 205-213.
7.	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.
8.	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.
9.	Wente MN, Veit JA, Bassi C, et al. Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery, 2007, 142(1): 20-25.
10.	Mahul BA, Stephen E, Frederick LG, et al. AJCC Cancer Staging Manual. 8th ed. New York: Springer, 2016: 219-241.
11.	Bosman FT, Carneiro F, Hruban RA, et al. WHO: classification of tumours of the digestive system. Lyon:IARC, 2010: 1-356.
12.	王倩, 蘇秀琴. 惡性梗阻性黃疸的病理生理改變. 實用醫技雜志, 2015, 22(3): 279-281.
13.	岳平, 張金鐸, 把永江, 等. 膽管惡性梗阻術前減黃的現狀及進展. 中國普外基礎與臨床雜志, 2017, 24(5): 644-648.
14.	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.
15.	Arkadopoulos N, Kyriazi MA, Papanikolaou IS, et al. Preoperative biliary drainage of severely jaundiced patients increases morbidity of pancreaticoduodenectomy: results of a case-control study. World J Surg, 2014, 38(11): 2967-2972.
16.	龔建平, 程瑤. 惡性梗阻性黃疸術前減黃的標準、指征及效果. 中國普外基礎與臨床雜志, 2018, 25(7): 781-783.
17.	Steen MW, van Rijssen LB, Festen S, et al. Impact of time interval between multidisciplinary team meeting and intended pancreatoduodenectomy on oncological outcomes. BJS Open, 2020, 4(5): 884-892.
18.	Duan F, Cui L, Bai Y, et al. Comparison of efficacy and complications of endoscopic and percutaneous biliary drainage in malignant obstructive jaundice: a systematic review and meta-analysis. Cancer Imaging, 2017, 17(1): 27. doi: 10.1186/s40644-017-0129-1.
19.	Coelen RJS, Roos E, Wiggers JK, et al. Endoscopic versus percutaneous biliary drainage in patients with resectable perihilar cholangiocarcinoma: a multicentre, randomised controlled trial. Lancet Gastroenterol Hepatol, 2018, 3(10): 681-690.
20.	桑慧, 李文潔, 周穎, 等. 膽汁酸、腸道微生物與膽管癌發生和發展關系的研究進展. 中華肝臟病雜志, 2021, 29(5): 493-496.
21.	Islam KB, Fukiya S, Hagio M, et al. Bile acid is a host factor that regulates the composition of the cecal microbiota in rats. Gastroenterology, 2011, 141(5): 1773-1781.
22.	Yamada S, Takashina Y, Watanabe M, et al. Bile acid metabolism regulated by the gut microbiota promotes non-alcoholic steatohepatitis-associated hepatocellular carcinoma in mice. Oncotarget, 2018, 9(11): 9925-9939.
23.	Ahn KS, Kang KJ, Kim YH, et al. Impact of preoperative endoscopic cholangiography and biliary drainage in ampulla of Vater cancer. Surg Oncol, 2018, 27(1): 82-87.
24.	Shen Z, Zhang J, Chen H, et al. Does pre-operative biliary drainage influence long-term survival in patients with obstructive jaundice with resectable pancreatic head cancer? Front Oncol, 2020, 10: 575316. doi: 10.3389/fonc.2020.575316.
25.	Mori S, Aoki T, Park KH, et al. Impact of preoperative percutaneous transhepatic biliary drainage on post-operative survival in patients with distal cholangiocarcinoma. ANZ J Surg, 2019, 89(9): E363-E367. doi: 10.1111/ans.15329.
26.	Simoneau E, Hassanain M, Shaheen M, et al. Portal vein embolization and its effect on tumour progression for colorectal cancer liver metastases. Br J Surg, 2015, 102(10): 1240-1249.
27.	Kokudo N, Tada K, Seki M, et al. Proliferative activity of intrahepatic colorectal metastases after preoperative hemihepatic portal vein embolization. Hepatology, 2001, 34(2): 267-272.
28.	Kim KM, Park JW, Lee JK, et al. A comparison of preoperative biliary drainage methods for perihilar cholangiocarcinoma: endoscopic versus percutaneous transhepatic biliary drainage. Gut Liver, 2015, 9(6): 791-799.
29.	Miura F, Sano K, Wada K, et al. Prognostic impact of type of preoperative biliary drainage in patients with distal cholangiocarcinoma. Am J Surg, 2017, 214(2): 256-261.

1. 王雷, 張向化, 伍路, 等. PTCD與ENBD對惡性梗阻性黃疸術前減黃效果的臨床比較. 肝膽胰外科雜志, 2019, 31(5): 310-313.
2. 潘孜博, 王宇宏, 孔哲, 等. 低位惡性梗阻性黃疸術前膽道引流方式的選擇. 中華肝膽外科雜志, 2020, 26(4): 259-264.
3. Fang Y, Gurusamy KS, Wang Q, 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.
4. Shen Z, Zhang J, Zhao S, et al. Preoperative biliary drainage of severely obstructive jaundiced patients decreases overall postoperative complications after pancreaticoduodenectomy: a retrospective and propensity score-matched nalysis. Pancreatology, 2020, 20(3): 529-536.
5. 邢穎, 張洪義. 惡性梗阻性黃疸術前減黃的方式及必要性探討. 中國醫刊, 2019, 37(7): 704-707.
6. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6 336 patients and results of a survey. Ann Surg, 2004, 240(2): 205-213.
7. 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.
8. 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.
9. Wente MN, Veit JA, Bassi C, et al. Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery, 2007, 142(1): 20-25.
10. Mahul BA, Stephen E, Frederick LG, et al. AJCC Cancer Staging Manual. 8th ed. New York: Springer, 2016: 219-241.
11. Bosman FT, Carneiro F, Hruban RA, et al. WHO: classification of tumours of the digestive system. Lyon:IARC, 2010: 1-356.
12. 王倩, 蘇秀琴. 惡性梗阻性黃疸的病理生理改變. 實用醫技雜志, 2015, 22(3): 279-281.
13. 岳平, 張金鐸, 把永江, 等. 膽管惡性梗阻術前減黃的現狀及進展. 中國普外基礎與臨床雜志, 2017, 24(5): 644-648.
14. 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.
15. Arkadopoulos N, Kyriazi MA, Papanikolaou IS, et al. Preoperative biliary drainage of severely jaundiced patients increases morbidity of pancreaticoduodenectomy: results of a case-control study. World J Surg, 2014, 38(11): 2967-2972.
16. 龔建平, 程瑤. 惡性梗阻性黃疸術前減黃的標準、指征及效果. 中國普外基礎與臨床雜志, 2018, 25(7): 781-783.
17. Steen MW, van Rijssen LB, Festen S, et al. Impact of time interval between multidisciplinary team meeting and intended pancreatoduodenectomy on oncological outcomes. BJS Open, 2020, 4(5): 884-892.
18. Duan F, Cui L, Bai Y, et al. Comparison of efficacy and complications of endoscopic and percutaneous biliary drainage in malignant obstructive jaundice: a systematic review and meta-analysis. Cancer Imaging, 2017, 17(1): 27. doi: 10.1186/s40644-017-0129-1.
19. Coelen RJS, Roos E, Wiggers JK, et al. Endoscopic versus percutaneous biliary drainage in patients with resectable perihilar cholangiocarcinoma: a multicentre, randomised controlled trial. Lancet Gastroenterol Hepatol, 2018, 3(10): 681-690.
20. 桑慧, 李文潔, 周穎, 等. 膽汁酸、腸道微生物與膽管癌發生和發展關系的研究進展. 中華肝臟病雜志, 2021, 29(5): 493-496.
21. Islam KB, Fukiya S, Hagio M, et al. Bile acid is a host factor that regulates the composition of the cecal microbiota in rats. Gastroenterology, 2011, 141(5): 1773-1781.
22. Yamada S, Takashina Y, Watanabe M, et al. Bile acid metabolism regulated by the gut microbiota promotes non-alcoholic steatohepatitis-associated hepatocellular carcinoma in mice. Oncotarget, 2018, 9(11): 9925-9939.
23. Ahn KS, Kang KJ, Kim YH, et al. Impact of preoperative endoscopic cholangiography and biliary drainage in ampulla of Vater cancer. Surg Oncol, 2018, 27(1): 82-87.
24. Shen Z, Zhang J, Chen H, et al. Does pre-operative biliary drainage influence long-term survival in patients with obstructive jaundice with resectable pancreatic head cancer? Front Oncol, 2020, 10: 575316. doi: 10.3389/fonc.2020.575316.
25. Mori S, Aoki T, Park KH, et al. Impact of preoperative percutaneous transhepatic biliary drainage on post-operative survival in patients with distal cholangiocarcinoma. ANZ J Surg, 2019, 89(9): E363-E367. doi: 10.1111/ans.15329.
26. Simoneau E, Hassanain M, Shaheen M, et al. Portal vein embolization and its effect on tumour progression for colorectal cancer liver metastases. Br J Surg, 2015, 102(10): 1240-1249.
27. Kokudo N, Tada K, Seki M, et al. Proliferative activity of intrahepatic colorectal metastases after preoperative hemihepatic portal vein embolization. Hepatology, 2001, 34(2): 267-272.
28. Kim KM, Park JW, Lee JK, et al. A comparison of preoperative biliary drainage methods for perihilar cholangiocarcinoma: endoscopic versus percutaneous transhepatic biliary drainage. Gut Liver, 2015, 9(6): 791-799.
29. Miura F, Sano K, Wada K, et al. Prognostic impact of type of preoperative biliary drainage in patients with distal cholangiocarcinoma. Am J Surg, 2017, 214(2): 256-261.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Analysis of curative effect for different preoperative biliary drainage methods in patients undergoing pancreaticoduodenectomy with low malignant obstructive jaundice

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