Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
SHR Neuro Krebs Kardio Lipid Stoffw Microb
Oehme, F; Hempel, S; Pecqueux, M; Müssle, B; Hau, HM; Teske, C; von, Bechtolsheim, F; Seifert, L; Distler, M; Welsch, T; Weitz, J; Kahlert, C.
Short-term preoperative drainage is associated with improved postoperative outcomes compared to that of long-term biliary drainage in pancreatic surgery.
Langenbecks Arch Surg. 2022; 407(3):1055-1063
Doi: 10.1007/s00423-021-02402-7
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- Co-Autor*innen der Med Uni Graz
- Hau Hans-Michael
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- Abstract:
- PURPOSE: The treatment of choice for patients presenting with obstructive cholestasis due to periampullary carcinoma is oncologic resection without preoperative biliary drainage (PBD). However, resection without PBD becomes virtually impossible in patients with obstructive cholangitis or severely impaired liver cell function. The appropriate duration of drainage by PBD has not yet been defined for these patients. METHODS: A retrospective analysis was conducted on 170 patients scheduled for pancreatic resection following biliary drainage between January 2012 and June 2018 at the University Hospital Dresden in Germany. All patients were deemed eligible for inclusion, regardless of the underlying disease entity. The primary endpoint analysis was defined as the overall morbidity (according to the Clavien-Dindo classification). Secondary endpoints were the in-hospital mortality and malignancy adjusted overall and recurrence-free survival rates. RESULTS: A total of 170 patients were included, of which 45 (26.5%) and 125 (73.5%) were assigned to the short-term (< 4 weeks) and long-term (≥ 4 weeks) preoperative drainage groups, respectively. Surgical complications (Clavien-Dindo classification > 2) occurred in 80 (47.1%) patients, with significantly fewer complications observed in the short-term drainage group (31.1% vs. 52%; p = 0.02). We found that long-term preoperative drainage (unadjusted OR, 3.386; 95% CI, 1.507-7.606; p < 0.01) and periampullary carcinoma (unadjusted OR, 5.519; 95% CI, 1.722-17.685; p-value < 0.01) were independent risk factors for postoperative morbidity, based on the results of a multivariate regression model. The adjusted overall and recurrence-free survival did not differ between the groups (p = 0.12). CONCLUSION: PBD in patients scheduled for pancreatic surgery is associated with substantial perioperative morbidity. Our results indicate that patients who have undergone PBD should be operated on within 4 weeks after drainage.
- Find related publications in this database (using NLM MeSH Indexing)
- Carcinoma - surgery
- Drainage - methods
- Duodenal Neoplasms - surgery
- Humans - administration & dosage
- Jaundice, Obstructive - surgery
- Pancreatic Neoplasms - pathology
- Pancreaticoduodenectomy - adverse effects, methods
- Postoperative Complications - administration & dosage
- Preoperative Care - methods
- Retrospective Studies - administration & dosage
- Treatment Outcome - administration & dosage
- Find related publications in this database (Keywords)
- Preoperative biliary drainage
- Pancreatic cancer
- Pancreatic surgery
- Complication