European surgical research. Europaische chirurgische Forschung. Recherches chirurgicales europeennes · 2026
Does Treatment of Jaundice Matter before Pancreaticoduodenectomy? Results from an International Multicentre Recurrence after Whipple (RAW) Study.
СтатьяМногоцентровое исследованиеНаблюдательное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Das Bibek, Robb Henry Douglas, Bobotis Stergios, Alghazawi Laith Omar Khalaf, Ashrafian Hutan, Pai Madhava, Fehervari Matyas, Aroori Somaiah, Spalding Duncan
Аннотация
INTRODUCTION: The management of jaundice before pancreaticoduodenectomy (PD) remains controversial. We aimed to analyse the clinical outcomes of jaundiced patients in a large cohort of PD patients stratified by treatment pathway.
METHODS: Data were collected from the Recurrence After Whipple's (RAW) study - an international, multicentre, retrospective cohort study of PD patients. Patients that underwent PD with subsequent histology confirmed pancreatic head ductal adenocarcinoma, ampullary adenocarcinoma, and distal cholangiocarcinoma were included in the RAW study. Patients were stratified into three groups by management of preoperative jaundice.
RESULTS: Patients (n = 1,172) were classified into three groups: surgery while jaundiced (n = 109), surgery after successful preoperative biliary drainage (PBD) (n = 777), and not jaundiced (n = 286). Jaundice was an independent predictor of poor survival, whether treated (HR 1.45, CI 1.20-1.76) or untreated (HR 1.55, CI 1.16-2.09) pre-operatively. On multivariate analysis, PBD was associated with improved disease-free survival (HR 0.75, CI 0.58-0.97) but not overall survival (HR 0.93, CI 0.72-1.20) relative to the untreated jaundiced population. PBD was associated with a reduced, but statistically nonsignificant, risk of PD-related complications (OR 0.63 CI 0.39-1.02; p = 0.059).
CONCLUSION: We observed a nonsignificant trend towards reduced perioperative complications and improved disease-free survival following PBD prior to PD.
METHODS: Data were collected from the Recurrence After Whipple's (RAW) study - an international, multicentre, retrospective cohort study of PD patients. Patients that underwent PD with subsequent histology confirmed pancreatic head ductal adenocarcinoma, ampullary adenocarcinoma, and distal cholangiocarcinoma were included in the RAW study. Patients were stratified into three groups by management of preoperative jaundice.
RESULTS: Patients (n = 1,172) were classified into three groups: surgery while jaundiced (n = 109), surgery after successful preoperative biliary drainage (PBD) (n = 777), and not jaundiced (n = 286). Jaundice was an independent predictor of poor survival, whether treated (HR 1.45, CI 1.20-1.76) or untreated (HR 1.55, CI 1.16-2.09) pre-operatively. On multivariate analysis, PBD was associated with improved disease-free survival (HR 0.75, CI 0.58-0.97) but not overall survival (HR 0.93, CI 0.72-1.20) relative to the untreated jaundiced population. PBD was associated with a reduced, but statistically nonsignificant, risk of PD-related complications (OR 0.63 CI 0.39-1.02; p = 0.059).
CONCLUSION: We observed a nonsignificant trend towards reduced perioperative complications and improved disease-free survival following PBD prior to PD.