title: Influence of preoperative biliary drainage on surgical outcome after pancreaticoduodenectomy: single centre experience.
abstract: OBJECTIVE
  Controversy prevails on the impact of preoperative biliary drainage (PBD) on postoperative complications and clinical outcome of pancreatic cancer. We determined whether PBD is associated with increased morbidity and mortality rates after pancreaticoduodenectomy.
  
  
  METHODS
  A total of 131 consecutive patients who underwent pancreaticoduodenectomy (93 jaundiced, 38 with no jaundice) were included in this study. Overall, 57 % of jaundiced patients underwent PBD, while 43 % were not drained. The impact of PBD on postoperative morbidity and mortality was evaluated by means of logistic regression analysis. The Kaplan-Meier method was applied to determine the effect of PBD on survival of patients with malignant lesions.
  
  
  RESULTS
  Mortality and morbidity rate was 3 % and 54.6 %, respectively. PBD was demonstrated to be the unique predictor of complications (odds ration [OR] = 10.18; 95 % confidence interval [CI], 3.65-28.39, p < 0.001). The jaundiced patients who were drained exhibited high frequencies of wound infection (p < 0.001), post-pancreatectomy haemorrhage (p = 0.0185) and hyperglycaemia (p < 0.001). In addition, an increased frequency of pancreatic fistula emerged among drained patients compared to those who were not drained (p = 0.036). PBD did not affect survival of patient with malignant lesions.
  
  
  CONCLUSIONS
  With the exception of the classical indications, PBD should be carefully evaluated in patients with resectable pancreatic cancer.
authors.affiliation: Division of Surgical Oncology, "SS Annunziata" Hospital, 66100, Chieti, Italy.
authors.forename: F Francesco
authors.initials: FF
authors.lastname: di Mola
authors.forename: Francesca
authors.initials: F
authors.lastname: Tavano
authors.forename: R Rita
authors.initials: RR
authors.lastname: Rago
authors.forename: Antonio
authors.initials: A
authors.lastname: De Bonis
authors.forename: M Rosa
authors.initials: MR
authors.lastname: Valvano
authors.forename: Angelo
authors.initials: A
authors.lastname: Andriulli
authors.forename: Pierluigi
authors.initials: P
authors.lastname: di Sebastiano
mesh_terms: D000368:Aged; D001652:Bile Ducts / Q000601:surgery; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality / Q000473:pathology / Q000601:surgery; D015331:Cohort Studies; D016001:Confidence Intervals; D004322:Drainage / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D041781:Jaundice, Obstructive / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000401:mortality / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome