Pancreaticoduodenectomy: does preoperative biliary drainage, method of pancreatic reconstruction or age influence...

Whether preoperative biliary drainage (PBD) is beneficial in reducing complications after pancreaticoduodenectomy is controversial. There remains a reluctance to consider pancreaticoduodenectomy in older patients. The major source of morbidity and potential mortality after pancreaticoduodenectomy is pancreatic fistula, which is caused by difficulties associated with the pancreatic anastomosis. The purpose of this study was to examine the effect of PBD, patient age and method of pancreatico-enteric reconstruction on postoperative morbidity and mortality.

A total of 104 consecutive patients undergoing pancreaticoduodenectomy between November 1992 and November 2004 were identified from a prospectively collected database. Multiple preoperative and intraoperative variables were examined and their relationship to postoperative outcome was analysed.

Postoperative mortality was <1%. Forty-three patients (43%) suffered a total of 85 complications. Median length of stay was 12.5 days (range, 1-88 days). The group undergoing PBD did not have higher rates of infectious complication (12 vs 19%; P = 0.34) or overall complication (41 vs 42%; P = 0.88) compared with the undrained group. Rate of anastomotic leak (18 vs 4%; P = 0.045) and anaemia requiring transfusion (41 vs 9%; P = 0.001) were significantly higher in the pancreaticojejunostomy group compared with the pancreaticogastrostomy group. Patients over the age of 70 years did not have higher rates of complication (44 vs 41%, P = 0.5) or postoperative length of stay.

Preoperative biliary drainage was not associated with increased postoperative complications. Pancreaticogastrostomy after pancreaticoduodenectomy is a safe and reliable method of reconstruction. Finally, pancreaticoduodenectomy can be carried out with acceptable rates of postoperative morbidity and mortality in selected patients over 70 years of age.