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  • Title: Preoperative biliary drainage in severely jaundiced patients with pancreatic head cancer: A retrospective cohort study.
    Author: van Gils L, Verbeek R, Wellerdieck N, Bollen T, van Leeuwen M, Schwartz M, Vleggaar F, Molenaar IQQ, van Santvoort H, van Hooft J, Verdonk R, Weusten B, of the Regional Academic Cancer Center Utrecht (RAKU).
    Journal: HPB (Oxford); 2022 Nov; 24(11):1888-1897. PubMed ID: 35803831.
    Abstract:
    BACKGROUND: Guidelines recommend against preoperative biliary drainage (PBD) in patients with pancreatic head cancer if bilirubin levels are <250 μmol/l. However, patients with higher bilirubin levels undergo PBD, despite the lack of supporting evidence. This study aims to evaluate outcomes in patients with a bilirubin level ≥250 and < 250. METHODS: Patients were identified from databases of 3 centers. Outcomes were compared in patients with a bilirubin level ≥250 versus <250 both at the time of diagnosis and directly prior to surgery. RESULTS: 244 patients were included. PBD was performed in 64% (123/191) with bilirubin <250 at diagnosis and 91% (48/53) with bilirubin ≥250. PBD technical success (83% vs. 81%, p = 0.80) and PBD related complications (33% vs. 29%, p = 0.60) did not differ between these groups. Analyzing bilirubin levels ≥250 versus <250 directly prior to surgery, no differences in severe postoperative complications and mortality were found. CONCLUSIONS: In patients with a pancreatic head cancer, PBD technical success and complications, and severe postoperative complications did not differ between patients with a bilirubin level ≥250 and < 250. Our study does not support a different approach regarding PBD in patients with severe jaundice.
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