Preoperative Surgical or Endoscopic Bile Duct Drainage in Pancreatic Cancer

OBJECTIVE: To compare short-term outcomes and survival in patients undergoing pancreatic head resection after preoperative endoscopic stenting (ES) versus preoperative surgical drainage (SD) through T-tube insertion. BACKGROUND: Patients with pancreatic cancer and obstructive jaundice routinely undergo ES placement. It is well known that ES causes bacterial contamination and infectious complications after pancreatic resection. METHODS: Patients with obstructive jaundice who underwent SD or ES from 2016 to 2022 were identified from a prospective database. Outcome analyses included microbiological bile contamination, overall morbidity, and assessment of the overall complication burden using the Comprehensive Complication Index. Overall survival was investigated by Kaplan-Meier analysis. RESULTS: A total of 55 patients who underwent SD were identified and matched with 110 patients who underwent ES. After the primary intervention, patients who underwent ES experienced more complications (ES: 17.3% vs SD: 3.6%; P = 0.013). The overall complication burden after pancreatic resection was higher in patients who underwent ES than in patients who underwent SD (Comprehensive Complication Index: 27.2 vs 19.9; P = 0.022). In addition, bacterial contamination of the bile was more frequent in patients who underwent ES compared with individuals who underwent SD (94.3% vs 7.1%; P < 0.001) with similar bacteria in 83.3% of postoperative abdominal infections in patients who underwent ES. While overall survival did not differ between the two groups, patients with postinterventional complications after ES had impaired survival compared with those without complications (11.3 vs 20.4 mo; P = 0.03). CONCLUSIONS: SD for obstructive jaundice in resectable pancreatic cancer is associated with a lower overall complication burden. In addition, patients with complications after ES experience worse overall survival. These findings indicate a rethink of our standards of treatment of obstructive jaundice in patients with pancreatic cancer.