A matched case-control study of preoperative biliary drainage in patients with pancreatic adenocarcinoma: Routine drainage is not justified Journal Article

  

Authors:	Mezhir, J. J.; Brennan, M. F.; Baser, R. E.; D'Angelica, M. I.; Fong, Y.; DeMatteo, R. P.; Jarnagin, W. R.; Allen, P. J.
Article Title:	A matched case-control study of preoperative biliary drainage in patients with pancreatic adenocarcinoma: Routine drainage is not justified
Abstract:	Background: Preoperative biliary drainage (PBD) prior to pancreaticoduodenectomy (PD) continues to be routine in many centers despite retrospective and randomized data showing that PBD increases perioperative infectious complications. Methods: Review of a prospectively maintained database identified 340 consecutive patients with pancreatic adenocarcinoma who underwent PD between 2000 and 2005. From this cohort, 94 PBD and 94 nonstented (no-PBD) patients were matched for age, gender, preoperative albumin, and bilirubin levels (PBD group: prestent bilirubin; no-PBD group: preoperative bilirubin). Results: The majority of PBD patients (89%) underwent internal endoscopic biliary drainage. Stent-related complications occurred in 46 patients (23%) and resulted in a significant delay in time to resection. In the matched-pair comparison, there was more operative blood loss in PBD patients, but similar operative times, transfusions, and hospital stay. Bile cultures were positive in 82% of PBD patients versus 7% no PBD. There was a statistically significant increase in infectious complications including wound infections and intra-abdominal abscess in PBD patients, but equal incidence of anastomotic leak. Conclusions: In this case-matched control study, PBD was associated with a stent-related complication rate of 23% and resulted in a twofold increase in postpancreatectomy infectious complications. The routine use of PBD remains unjustified. © 2009 The Society for Surgery of the Alimentary Tract.
Keywords:	adult; aged; aged, 80 and over; middle aged; case control study; case-control studies; preoperative care; pancreatic neoplasms; pancreaticoduodenectomy; adenocarcinoma; bleeding; postoperative complication; postoperative complications; pancreas tumor; stent; complications; pancreatic cancer; blood loss, surgical; drainage; stents; biliary drainage; bile duct; digestive tract endoscopy; endoscopic retrograde cholangiopancreatography; wound drainage; bile ducts; cholangiopancreatography, endoscopic retrograde; endoscopy, digestive system
Journal Title:	Journal of Gastrointestinal Surgery
Volume:	13
Issue:	12
ISSN:	1091-255X
Publisher:	Springer
Date Published:	2009-12-01
Start Page:	2163
End Page:	2169
Language:	English
DOI:	10.1007/s11605-009-1046-9
PUBMED:	19774424
PROVIDER:	scopus
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-71149107466&partnerID=40&md5=d7c3f2000ed427402e97d82f63d2ef2f
Notes:	--- - "Cited By (since 1996): 1" - "Export Date: 30 November 2010" - "Source: Scopus"

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