Preoperative biliary drainage associated with biliary stricture after pancreaticoduodenectomy: a population-based study.

Abstract

BACKGROUND:

The rate of preoperative biliary drainage for pancreaticoduodenectomy has been increasing despite most recent evidence that favors avoiding it. Only a few studies have focused on late surgical complications - biliary stricture after pancreaticoduodenectomy and have produced only inconclusive results. We evaluate the role of preoperative biliary drainage in the formation of biliary stricture after pancreaticoduodenectomy.

METHODS:

The Taiwan National Health Insurance Program is a mandatory health care plan that covers nearly the entire population of 23 million in this country. A retrospective study was conducted to analyze the database compiled by the Taiwan National Health Insurance between January 2000 and December 2011. We included only patients with at least 2 years of follow-up. A cohort of 2,087 patients with preoperative diagnosis of biliary obstruction that underwent pancreaticoduodenectomy was evaluated.

RESULTS:

A total of 212 (10.1%) of the 2,087 studied patients needed intervention for biliary stricture after pancreaticoduodenectomy. The median time to biliary stricture formation was 15.2 months (range: 1.2-89.7 months). The cumulative biliary stricture rate was 6.9% (1 year), 15.8% (5 years), and 18.5% (10 year). Multivariate analysis showed preoperative biliary drainage (hazard ratio 1.78, 95% CI 1.27-2.50, P = 0.001) associated with biliary stricture after pancreaticoduodenectomy.

CONCLUSIONS:

Preoperative biliary drainage increases biliary stricture rate after pancreaticoduodenectomy.

• Authors: Chien-Hui Wu, Te-Wei Ho, Jin-Ming Wu, Ting-Chun Kuo, Ching-Yao Yang, Fei-Pei Lai, Yu-Wen Tien
• Journal: Journal of hepato-biliary-pancreatic sciences (J Hepatobiliary Pancreat Sci) Vol. 25 Issue 6 Pg. 308-318 (Jun 2018) ISSN: 1868-6982 [Electronic] Japan
• PMID: 29736970 (Publication Type: Evaluation Study, Journal Article)
• Copyright: © 2018 Japanese Society of Hepato-Biliary-Pancreatic Surgery.

Topics

• Aged
• Analysis of Variance
• Bile Duct Neoplasms (diagnostic imaging, mortality, pathology, surgery)
• Cholangiopancreatography, Endoscopic Retrograde (methods)
• Cholestasis (diagnostic imaging, etiology, surgery)
• Cohort Studies
• Databases, Factual
• Drainage (adverse effects, methods)
• Female
• Follow-Up Studies
• Humans
• Logistic Models
• Male
• Middle Aged
• Multivariate Analysis
• Pancreaticoduodenectomy (adverse effects, methods)
• Postoperative Complications (diagnostic imaging, etiology, surgery)
• Preoperative Care (methods)
• Proportional Hazards Models
• Retrospective Studies
• Risk Assessment
• Stents
• Survival Rate
• Taiwan