Table_5_Impact of preoperative biliary drainage on postoperative complications and prognosis after pancreaticoduodenectomy: A single-center retrospective cohort study.xlsx

Background and objectivesObstructive jaundice is common in patients with pancreaticobiliary malignancies. Preoperative biliary drainage (PBD) can alleviate cholestasis; however, no consensus has been reached on the impact of PBD on the incidence of surgery-related complications and patient survival. This study aimed to evaluate the effect among patients treated with PBD.
MethodsThis retrospective study examined the clinical and follow-up prognostic data of 160 patients with pancreaticobiliary malignancies who underwent pancreaticoduodenectomy (PD) at Beijing Friendship Hospital, Capital Medical University, from January 2016 to July 2020. Outcomes were compared between patients who underwent PBD (PBD group) and those who did not (control group). Changes in biochemical indicators were evaluated before and after drainage in the PBD group. Between-group differences in inflammatory indicators after PD were assessed using the Wilcoxon signed-rank test. Postoperative complications were classified according to the Clavien-Dindo classification system. The effects of PBD and biliary drainage efficiency on postoperative complications were evaluated using the chi-square test and binary logistics regression. The Kaplan-Meier analysis was used for between-group comparison of survival analysis. Univariate and multivariate regression analyses were performed to identify prognostic factors of survival.
ResultsTotal 160 patients were enrolled,the mean age of the study sample was 62.75 ± 6.75 years. The distribution of pancreaticobiliary malignancies was as follows: 34 cases of pancreatic head cancer, 61 cases of distal bile duct cancer, 20 cases of duodenal papilla cancer, 39 cases of duodenal ampullary cancer, and 6 cases of malignant intraductal papillary mucinous neoplasm (IPMN). PBD was performed in 90 of the 160 patients, with PBD performed using an endoscopic retrograde cholangiopancreatography (ERCP) approach in 55 patients and with percutaneous transhepatic cholangiography (PTC) used in the remaining 35 cases. The mean duration of drainage in the PBD group was 12.8 ± 8.8 days. The overall rate of complications was 48.05% (37/77) in the control group and 65.55% (59/90) in the PBD group with non-significant difference (χ2 = 3.527, p=0.473). In logsitics regression analysis, PBD was also not a risk factor for postoperative complications OR=1.77, p=0.709). The overall rate of postoperative complications was significantly higher among patients who underwent PBD for >2 weeks (χ2 = 6.102, p=0.013), with the rate of severe complications also being higher for this subgroup of PBD patients (χ2 = 4.673, p=0.03). The overall survival time was 47.9 ± 2.45 months, with survival being slightly lower in the PBD group (43.61 ± 3.26 months) than in the control group (52.24 ± 3.54 months), although this difference was not significant (hazard ratio (HR)=0.65, p=0.104).
ConclusionIn patients with malignant biliary obstruction, PBD does not affect the incidence of postoperative complications after pancreaticoduodenectomy nor does it affect patient survival. Prolonged biliary drainage (>2 weeks) may increase the incidence of overall postoperative complications and severe complications.

背景与目的 梗阻性黄疸在胰胆恶性肿瘤患者中较为多见。术前胆道引流（preoperative biliary drainage, PBD）可缓解胆汁淤积，但目前针对PBD对手术相关并发症发生率及患者生存预后的影响尚未达成统一共识。本研究旨在评估PBD在该类患者中的应用效果。
方法 本回顾性研究纳入了2016年1月至2020年7月于首都医科大学北京友谊医院接受胰十二指肠切除术（pancreaticoduodenectomy, PD）的160例胰胆恶性肿瘤患者的临床及随访预后资料。将患者分为术前接受PBD的PBD组与未接受PBD的对照组，对比两组的临床结局。对PBD组患者引流前后的生化指标变化进行评估。采用Wilcoxon符号秩检验比较两组患者胰十二指肠切除术后的炎症指标差异。术后并发症依据Clavien-Dindo分类系统进行分级。采用卡方检验及二元logistic回归分析评估PBD及胆道引流效率对术后并发症的影响。采用Kaplan-Meier分析进行两组患者的生存对比。通过单因素及多因素回归分析筛选患者生存的预后影响因素。
结果 本研究共纳入160例患者，研究样本的平均年龄为62.75±6.75岁。胰胆恶性肿瘤的分布情况如下：胰头癌34例、远端胆管癌61例、十二指肠乳头癌20例、十二指肠壶腹癌39例、恶性导管内乳头状黏液性肿瘤（intraductal papillary mucinous neoplasm, IPMN）6例。160例患者中90例接受了PBD，其中55例采用内镜逆行胰胆管造影（endoscopic retrograde cholangiopancreatography, ERCP）途径，剩余35例采用经皮肝穿刺胆管造影（percutaneous transhepatic cholangiography, PTC）途径。PBD组患者的平均引流时长为12.8±8.8天。对照组术后并发症总发生率为48.05%（37/77），PBD组为65.55%（59/90），组间差异无统计学意义（χ²=3.527，P=0.473）。二元logistic回归分析显示，PBD并非术后并发症的危险因素（优势比（odds ratio, OR）=1.77，P=0.709）。其中，引流时长超过2周的PBD患者术后并发症总发生率显著升高（χ²=6.102，P=0.013），该亚组患者的严重并发症发生率也更高（χ²=4.673，P=0.03）。所有患者的总生存时间为47.9±2.45个月，PBD组患者的生存时间（43.61±3.26个月）略低于对照组（52.24±3.54个月），但该差异无统计学意义（风险比（hazard ratio, HR）=0.65，P=0.104）。
结论 对于恶性胆道梗阻患者，PBD既不会影响胰十二指肠切除术后的并发症发生率，也不会对患者的生存预后产生影响。但延长胆道引流时长（>2周）可能会增加术后总体并发症及严重并发症的发生风险。