Influence of preoperative biliary drainage on postoperative morbidity and mortality after pancreatoduodenectomy

Pancreatoduodenectomy is the only potentially curative treatment for peripapillary tumors. However, postoperative mortality remains as high as 5% and as many as 50% of patients have postoperative morbidity. Preoperative endoscopic retrograde cholangiopancreatography and placement of a biliary drainage stent aim to achieve a precise diagnosis, reduce jaundice and improve the results of surgery for biliary malignancies, but the effectiveness of preoperative biliary drainage in the prevention of postoperative infections is controversial. A retrospective analysis was performed in a series of 58 patients with periampullary tumors who underwent pancreatoduodenectomy and the relationship between preoperative biliary drainage and postoperative complications was examined. Biliary drainage (25.8%) before pancreatoduodenectomy was significantly associated with more frequent biliary and pancreatic anastomotic leakage (60% with drainage versus 20.9% without drainage), higher postoperative morbidity, and greater mean postoperative length of hospital stay (33.3 days with drainage versus 21.6 without drainage). No significant difference was found between the two groups in postoperative mortality at 30 days (13.7%). The effectiveness of biliary drainage before surgery in patients with pancreatic and peripancreatic lesions has not been well established, but we believe that this procedure should be avoided whenever possible in patients with potentially resectable pancreatic and peripancreatic lesions. Prospective randomized studies are required to clarify the indications for preoperative biliary drainage in these patients.