Preoperative Cholangiostomy for Pancreatic Head Cancer

The question of the need for routine preoperative drainage of the biliary tree in peripapillary tumor obstruction is still debatable.
We conducted a retrospective randomized single–center study, the first control point of which was to study the safety of percutaneous drainage, the second was the effect of preoperative drainage on the number of postoperative complications in pancreatoduodenectomy (PD).
The results of 85 Whipple’s PD for a tumor of the head of the pancreas were analyzed. Preoperative biliary drainage (PBD) was performed in 75 (88.2 %) cases and was represented by percutaneous transhepatic cholangiostomy. 10 (11.8 %) patients did not undergo PBD.
In the preoperative period, the level of plasma bilirubin and the severity of mechanical jaundice were assessed according to E.I. Galperin, 2014. The frequency of postoperative complications was assessed, both after performing PBD and after PD, the severity was graded according to the Clavien–Dindo scale.
The technical success of cholangiostomy was achieved in 100 % of cases, the clinical efficacy of PBD is represented by a significant decrease in serum bilirubin levels and a decrease in the severity of jaundice.
Complications of transcutaneous interventions on the biliary tree corresponded to III A of the Clavien– Dindo scale and did not affect the preoperative status.
Complications of PD among patients without PBD corresponded to classes IIIA and V of the Clavien–Dindo scale: failure of pancreatojejunostomy (30  %, 3 out of 10) with the formation of pancreatic fistula, complete or partial failure of hepaticojejunostomy (30 %, 3 out of 10). Infectious complications in the form of abdominal abscesses and suppuration of a postoperative wound were found in 20 % (2 out of 10).
In patients after PBD, PD complications corresponded to classes IIIA and IIIB of the Clavien–Dindo scale: partial failure of pancreatojejunostomy and pancreatic accumulations of the abdominal cavity (18.7 %), acute pancreatitis (12 %) and focal pancreatic necrosis (12 %), partial failure of hepaticojejunostomy (6.7 %). Abscesses of the abdominal cavity and retroperitoneal space, infection of the wound were noted in 14.7 %.
After PD, the mortality rate was 6 (7.1 %) cases, of which 3 (30 %, 3 out of 10) patients without PBD and 3 (4 %) patients with cholangiostomy.
Using contingency tables with the calculation of Fisher’s exact test and Pearson’s contingency coefficient, it was found that PBD does not affect the frequency of complications from pancreatojejunostomy and the development of infectious complications; the absence of cholangiostomy significantly leads to an increase in the frequency of hepaticojejunostomy failure.

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