Preoperative Biliary Drainage in Patients With Operable Malignant Periampulary Tumors

"Impact of Preoperative Biliary Drainage on Surgical and Oncologic Outcomes After Pancreatico-Duodenectomy in Patients With Operable Malignant Periampulary Tumors. A Randomized Controlled Study"

The impact of preoperative biliary drainage (PBD) on morbidity and mortality associated with Pancreaticoduodenectomy (PD) in patients with peri-ampulary tumors is still controversial. The objective of this study is to evaluate the impact of PBD on surgical and oncologic outcomes after PD in jaundiced patients with operable peri-ampulary tumors.

150 consecutive jaundiced patients with suspected operable peri-ampullary tumors were randomized via concealed envelopes into 2 groups (each included 75 patients), group I managed by direct surgery while group II managed by PBD followed by surgery. Both groups were compared regarding perioperative mortality, morbidities, tumor recurrence and 2 years survival rates.

Inclusion Criteria:

• Serum bilirubin level above 4 mg/dl
• suspected peri-ampullary tumor at computed tomography (CT)
• No evidence of distant metastasis or locally advanced tumor

Exclusion Criteria:

• Patients with evidence of distant metastasis or locally advanced tumor
• Prior neoadjuvant chemotherapy or Radiotherapy
• Prior biliary surgery
• Patients with contraindication for major surgery