Goal-oriented preoperative biliary drainage is more precise and conducive to seize the opportunity for pancreaticoduodenectomy

作者：Hongtao Cao, Tianyu Li, Zeru Li, Bangbo Zhao, Ziwen Liu, Weibin Wang · 发表于：World Journal of Surgical Oncology · 年份：2024 · DOI：10.1186/s12957-024-03615-y · 被引用次数：5 · 研究领域：Pancreatic and Hepatic Oncology Research、Gallbladder and Bile Duct Disorders、Pancreatitis Pathology and Treatment

BACKGROUND: Preoperative biliary drainage (PBD) for selected patients with severe juandice has been shown to improve clinical conditions for pancreaticoduodenectomy (PD) and reduce the risk of post-pancreatectomy hemorrhage (PPH). However, the determination of an optimal end-point for PBD remains unclear. The aim of this research is to introduce the concept of goal-oriented biliary drainage, which may serve as a reasonable target and identify the optimal surgery time window. METHODS: The clinical data of 194 patients diagnosed with pancreatic cancer and obstructive jaundice were retrospectively analyzed. Serological laboratory examinations including total bilirubin (TBIL) within one week before PBD and PD were recorded and labeled as TBIL-pre and TBIL-post respectively. PBD and PD were performed by experienced medical teams. PPH with grade B and C were enrolled. RESULTS: TBIL-post less than 93.0µmol/L (sensitivity 83.78%, specificity 72.61%) or TBIL decay more than 68.5% (sensitivity 86.49%, specificity 69.43%) identified through ROC curves and multivariate analysis were independent protective factors for reducing the risk of PPH (OR 0.234 and 0.191 retrospectively, P<0.05) and were established as PBD goals. The Kaplan-Meier curves demonstrated the median time to achieve both PBD goals was 3 weeks. Additionally, the proportion of patients achieving both goals failed to increase with the PBD duration over 6 weeks (P > 0.05). The proportion of TBIL-post ≤ 93.0µmol/L (70.8% vs. ...