Impact of obstructive jaundice severity and preoperative biliary drainage on laparoscopic pancreaticoduodenectomy: a bicentric retrospective cohort analysis of 879 cases.

BACKGROUND

Obstructive jaundice elevates perioperative risks in laparoscopic pancreaticoduodenectomy (LPD), though the clinical utility of preoperative biliary drainage (PBD) remains controversial. This study investigated the prognostic significance of jaundice severity and the clinical value of PBD strategies in LPD outcomes.

METHODS

We conducted a retrospective analysis of 879 consecutive LPD patients from two tertiary hospitals in southwest China. Propensity score matching (PSM) was applied to balance baseline characteristics. Multivariable logistic regression was used to identify whether different jaundice degrees were independent risk factors for postpancreatectomy hemorrhage. Interventional outcomes in the biliary drainage and non-drainage groups were compared, with subgroup analyses being performed to specifically evaluate endoscopic retrograde cholangiopancreatography (ERCP) versus percutaneous transhepatic cholangial drainage (PTCD) efficacy.

RESULTS

Patients with severe jaundice (total bilirubin ≥  171 μmol/L) demonstrated significantly elevated postpancreatectomy hemorrhage (PPH) risk compared to mild and moderate jaundice groups (10.53% vs. 5.77% vs. 2.68%, p = 0.03), though no significant difference existed between mild and moderate groups (5.77% vs. 2.68%, p = 0.22). Multivariate logistic regression analysis confirmed severe jaundice as an independent hemorrhage predictor (OR = 2.557, 95% CI: 1.160 - 5.637, p = 0.02). PBD implementation in severe jaundice significantly mitigated PPH risk (4.13% vs. 12.70%, p = 0.03). ERCP and PTCD exhibited comparable clinical efficacy.

CONCLUSION

Severe obstructive jaundice is an independent risk factor for post-LPD hemorrhage, which warrants the implementation of preoperative biliary drainage. Both ERCP and PTCD effectively reduce bilirubin levels and mitigate PPH risk. These findings suggest PBD strategies for severe jaundice patients undergoing LPD.