The impact of preoperative biliary drainage on short-term outcomes after pancreaticoduodenectomy: a propensity score-matched analysis
10.3760/cma.j.cn113884-20250429-00142
- VernacularTitle:术前胆道引流对胰十二指肠切除术后早期结局影响的倾向性评分匹配研究
- Author:
Xuean ZHAO
1
;
Tao LUO
1
;
Xin LI
1
;
Hui ZHANG
1
;
Wence ZHOU
1
Author Information
1. 兰州大学第二医院（第二临床医学院），兰州 730000
- Publication Type:Journal Article
- Keywords:
Pancreaticoduodenectomy;
Obstructive jaundice;
Preoperative biliary drainage;
Postoperative complications;
Propensity score matching
- From:
Chinese Journal of Hepatobiliary Surgery
2025;31(11):836-841
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the impact of preoperative biliary drainage (PBD) on early postoperative outcomes in patients undergoing pancreaticoduodenectomy (PD) for malignant obstructive jaundice of varying severity.Methods:Clinical data of 346 patients who underwent PD at the Second Hospital of Lanzhou University between January 2019 and December 2024 were retrospectively analyzed, including 229 males and 117 females, aged (62.2±8.9) years. Pathological diagnoses included pancreatic malignancy (121 cases, 35.0%), bile duct malignancy (128 cases, 37.0%), duodenal malignancy (76 cases, 22.0%), and ampullary malignancy (21 cases, 6.0%). Based on a preoperative total bilirubin cutoff of 171 μmol/L, patients were stratified into a mild jaundice group ( n=133, total bilirubin <171 μmol/L) and a moderate-to-severe jaundice group ( n=213, total bilirubin ≥171 μmol/L). Each group was further divided into PBD and non-PBD subgroups. After propensity score matching, 36 pairs were matched in the mild jaundice group and 30 pairs in the moderate-to-severe jaundice group. Intraoperative blood loss, operation time, R 0 resection rate, postoperative complications (pancreatic fistula, bile leakage, postoperative hemorrhage, etc.), severe complications (Clavien-Dindo grade Ⅲ or above), total hospital stay, and total hospitalization costs were compared between the PBD and non-PBD groups. Results:In both the mild and moderate-to-severe jaundice groups, no statistically significant differences were observed between the PBD and non-PBD groups regarding intraoperative blood loss, operation time, or R 0 resection rate (all P>0.05). In the mild jaundice group, the total hospital stay [28.5 (24.0, 37.5) days] and total hospitalization costs [9.4 (7.8, 10.8) wanyuan] in the PBD group were significantly higher than those in the non-PBD group [22.0 (19.0, 29.0) days and 8.1 (7.0, 10.2) wanyuan, respectively)] ( Z=3.94, P<0.001; Z=2.25, P=0.025). In the moderate-to-severe jaundice group, the total hospital stay in the PBD group [28.5 (24.8, 36.0) days] was significantly longer than that in the non-PBD group [21.5 (20.8, 30.8) days] ( Z=2.68, P=0.007). The overall incidence of postoperative complications did not differ significantly between the PBD and non-PBD groups in either jaundice severity cohort (all P>0.05). However, in the moderate-to-severe jaundice group, the incidence of severe complications in the PBD group (16.7%, 5/30) was significantly lower than that in the non-PBD group (43.3%, 13/30) ( χ2=5.08, P=0.024). Conclusion:PBD brought no significant benefit in patients undergoing PD with mild jaundice but increased the financial burden, which may recommended for routine use. In patients undergoing PD with moderate-to-severe jaundice, PBD helped reduce severe complications despite a prolonged hospitalization. which is recommended after comprehensive evaluation.
