title: Value of preoperative biliary drainage in a consecutive series of resectable periampullary lesions. From randomized studies to real medical practice.
abstract: BACKGROUND
  In cases with periampullary tumors, the practice of preoperative biliary drainage (PBD) is still debated without clear uniform indications. Our study focused on resectable cases with an obstructive jaundice candidate for curative surgery. Main endpoints were overall complication and mortality rates between patients treated with and without PBD.
  
  
  METHODS
  From January 2008 to November 2010, 100 consecutive patients with periampullary lesion underwent pancreatectomy. The rates of postoperative complications and mortality were compared between PBD and non-PBD patients.
  
  
  RESULTS
  The two groups were well matched for demographics, clinical, and operative characteristics. In patients who completed preoperative PBD protocol, biliary stent was placed systematically in 45 % of these cases without any clear indication. Post-PBD complication delayed surgery in 24 % of cases. Postoperative complications did not differ significantly between the two groups except for a significantly higher positive bile culture in PBD group (p = 0.001). There were seven cases of hospital mortality, four in PBD and three in non-PBD group. DFS was equal (32 months) in both groups (p = 0.55), and OS was 43 vs 32 months (p = 0.45).
  
  
  CONCLUSIONS
  PBD did not significantly increase the risk of overall postoperative complications, although it was associated to higher rate of biliary infections. PBD was not associated with any advantages in patients with a resectable periampullary lesion by reducing operative morbidity. PBD should be considered in selected patients when surgery has to be delayed.
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, Edouard Herriot Hospital, Faculty of Medicine, 5 Place d'Arsonval, Lyon Cedex 03, France.
authors.forename: Jumpol
authors.initials: J
authors.lastname: Singhirunnusorn
authors.forename: Lebeau
authors.initials: L
authors.lastname: Roger
authors.forename: Xavier
authors.initials: X
authors.lastname: Chopin-Laly
authors.forename: Vincent
authors.initials: V
authors.lastname: Lepilliez
authors.forename: Thierry
authors.initials: T
authors.lastname: Ponchon
authors.forename: Mustapha
authors.initials: M
authors.lastname: Adham
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D041781:Jaundice, Obstructive / Q000209:etiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000150:complications / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D015607:Stents; D016896:Treatment Outcome