Objective: 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 was 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 non-significant, risk of PD-related complications (OR 0.63 CI 0.39 – 1.02; p = 0.059). Conclusions: We observed a non-significant trend towards reduced perioperative complications and improved disease-free survival following PBD prior to PD.
Das et al. (Wed,) studied this question.