Preoperative Biliary Drainage of Jaundiced Patients with Pancreatic Head Cancer: A Routine or Selective Strategy | Chapter 5 | Highlights on Medicine and Medical Research Vol. 9

At the time of diagnosis, the majority of patients with pancreatic head cancer (85%) are jaundiced. It is hypothesized that obstructive jaundice increases the risk of perioperative and postoperative problems. Preoperative biliary drainage (PBD) improves postoperative outcomes, according to certain experimental and clinical investigations. PBD, on the other hand, has been linked to an increased risk of postoperative complications in a number of randomized studies. As a result, whether or not to use PBD is debatable. The goal is to see if PBD can be used as a routine or selected treatment in these patients.

Methods and Materials: A retrospective study from the 2nd Department of Surgery-Hellenic Red Cross Hospital of Athens compared PBD to surgery alone in 200 jaundiced patients with pancreatic head malignancy (1996-2011). Age, gender, smoking, diabetes history, laboratory parameters, procedures, and post-operative course are all data from patient files. The majority of patients (62.5 percent) were men, with 93.5 percent having adenocarcinoma, 65.0 percent being smokers, and half being diabetics. PBD was conducted in 74 patients (37.0 percent) with higher laboratory values (Direct bilirubin 18 mg/dl versus 13 mg/dl). The median age was 70 years, and the median tumor size was 5 cm. Total bilirubin (24 mg/dl vs. 20 mg/dl) was significantly greater in this group, with increased surgical complications, ICU admissions, and postoperative mortality (17.6 percent vs 5.6 percent ).

Conclusion: We feel that PBD should be used only in jaundiced patients with pancreatic head cancer who have a fever, are non-operable, or have advanced disease as a palliative option because it increases the likelihood of postoperative complications.

Author (s) Details

Fernand Tshijanu
2nd Department of General Surgery and Surgical Oncology Unit, Hellenic Red Cross Hospital of Athens, Greece.

Anastasios Xiarchos
2nd Department of General Surgery and Surgical Oncology Unit, Hellenic Red Cross Hospital of Athens, Greece.

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