Impact of Preoperative Biliary Drainage on Perioperative Outcomes after Pancreatico-Duodenectomy in Periampullary Malignancies

Introduction: There has been an incessant debate regarding drainage of malignant obstructive jaundice for periampullary lesions as well as the timing of surgery post biliary drainage. Methods: We conducted a retrospective review of a prospectively maintained database of patients operated for pancreatico-duodenectomy for pancreatic head/periampullary malignancies at Tata Memorial Center (Homi Bhabha National Institute), Mumbai. Study period was from March 2016 to March 2020. Results: A total of 472 patients underwent pancreaticoduodenectomy at our institute for periampullary or pancreatic adenocarcinoma during the time period. Preoperative biliary drainage (PBD) was performed for 344 (73%). The median presenting bilirubin level was 4gm/dl (0.7-41gm/dl). PBD was achieved in the form of PTBD (6.4%) or ERCP (93.6%). Amongst PBD patients, 50 out of 344 required restenting due to stent block with or without cholangitis. Multiple stent exchange (> twice) was required in 1.2%. Perioperative morbidity (Clavein Dindo ³ IIIa) was 32.8%, 36 %, 34% amongst patients undergoing No PBD, PBD, restenting respectively whereas 90 day-mortality was 1.6%, 4% and 2% respectively. Conclusion: PBD with ERCP and primary or restenting results in similar morbidity in patients undergoing pancreaticoduodenectomy for periampullary or pancreatic cancer. [MSB1]P value of comparison will be required.