Complications of pancreaticoduodenectomy after neoadjuvant chemoradiation in patients with and without preoperative biliary drainage.
BACKGROUND
It has been suggested that preoperative biliary drainage increases the risk of infectious complications of pancreaticoduodenectomy.


OBJECTIVE
The aim of this study was to assess complications related to biliary stents/drains and postoperative morbidity in patients undergoing neoadjuvant chemoradiotherapy for periampullary cancer.


METHODS
One hundred and eighty-four patients with periampullary neoplasms were prospectively selected for neoadjuvant external beam radiation therapy and 5-fluorouracil-based chemotherapy between 1995 and 2002.


METHODS
The data were retrospectively completed and analysed with respect to biliary drainage, efficacy and complications of endoscopic biliary stents and postoperative morbidity. Patients who had undergone a surgical biliary bypass were excluded.


RESULTS
Data were completed in 168 patients. One hundred and nineteen patients were treated with endoscopic biliary stents, 18 patients had a percutaneous biliary drain and 31 patients did not require biliary drainage. Hospitalisation for stent-related complications was necessary in 15% of the patients with endoscopic biliary stents. Seventy-two patients underwent pancreaticoduodenectomy. There was no significant difference in the rate of wound infections, intra-abdominal abscesses and overall complications between the groups with and without preoperative biliary drainage.


CONCLUSIONS
Postoperative infectious complications are common in patients both with and without preoperative biliary drainage. A statistically significant difference in complication rates was not observed between these groups.
Gerke
H
H
Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Box 3189, Durham, NC 27710, USA. henninggerke@web.de
White
R
R
Byrne
M F
MF
Stiffier
H
H
Mitchell
R M
RM
Hurwitz
H I
HI
Morse
M A
MA
Branch
M S
MS
Jowell
P S
PS
Czito
B
B
Clary
B
B
Pappas
T N
TN
Tyler
D S
DS
Baillie
J
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D001646:Bile; D017024:Chemotherapy, Adjuvant; D004322:Drainage; D016145:Endoscopy, Digestive System; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D006801:Humans; D041781:Jaundice, Obstructive / Q000209:etiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D010190:Pancreatic Neoplasms / Q000628:therapy*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000401:mortality; D011300:Preoperative Care; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D015607:Stents
D000964:Antimetabolites, Antineoplastic; D005472:Fluorouracil