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Endoscopy I
PMO-217 Preoperative endoscopic biliary drainage and short-term clinical outcome following pancreaticoduodenectomy for pancreatic adenocarcinoma: site-specific factors
  1. E Scott1,
  2. D Mole1,
  3. A Miller2,
  4. R Ravindran1,
  5. E Hidalgo3,
  6. M Duxbury1
  1. 1Clinical Surgery, University and Royal Infirmary of Edinburgh, Edinburgh, UK
  2. 2Endoscopy Unit, Royal Infirmary of Edinburgh, Edinburgh, Edinburgh, UK
  3. 3Department of Surgery, St James' University Hospital, Leeds, UK

Abstract

Introduction The role of preoperative endoscopic biliary drainage (PEBD) prior to pancreaticoduodenectomy (PD) remains controversial. We sought to determine the effects of PEBD on the short-term outcome of initially jaundiced patients undergoing PD for pancreatic adenocarcinoma in a regional Hepatopancreaticobiliary (HPB) Surgery unit.

Methods 100 consecutive initially jaundiced patients undergoing PD for histologically-confirmed pancreatic adenocarcinoma at our institution between 2006 and 2009 were identified from a prospectively maintained database. Patient demographics, perioperative serum bilirubin levels, surgical complications (Clavien classification), length of inpatient stay and in-hospital mortality were assessed. The use of PEBD, the location in which PEBD was performed, and time from PEBD to PD were ascertained. Three patient groups were defined: 1. No PEBD, 2. PEBD in HPB surgery unit (PEBD-HPB) and 3. PEBD in non-HPB surgery unit (PEBD-nHPB). Patients undergoing preoperative percutaneous biliary intervention were excluded from the study.

Results Mean patient age was 66 years (SD=11.9), M:F=56:44. 74/100 patients underwent PEBD prior to PD, of whom 53 (72%) patients underwent PEBD-HPB and 21 (28%) underwent PEBD-nHPB. In-hospital mortality did not significantly differ between the three patient groups. Mean preoperative serum bilirubin was significantly higher in No PEBD group (p<0.01). Mean length of inpatient stay and occurrence of documented infective wound complications were significantly higher in the PEBD-nHPB group vs PEBD-HPB and No PEBD groups (p=0.035). Mean time from PEBD to PD was significantly higher in the PEBD-nHPB vs the PEBD-HPB group (p=0.045).

Conclusion In this albeit small sample of patients, PEBD prior to PD did not significantly affect indicators of short-term perioperative morbidity and mortality. PEBD may be detrimental when performed in non-HPB surgical units. While increased time from PEBD to PD may play a role, the cause of this association remains to be determined. The role of PEBD prior to PD warrants further evaluation in the context of a well-designed prospective clinical trial.

Competing interests None declared.

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