ArticleTranslational gastroenterology and hepatology2026
Impact of preoperative biliary drainage on surgical risk in pancreaticoduodenectomy for resectable periampullary tumors.
Article in Translational gastroenterology and hepatology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Pancreaticoduodenectomy (PD), as a challenging surgical procedure, is associated with considerable morbidity and mortality rates. Currently, the impact of preoperative biliary drainage (PBD) on the surgical risk of PD remains controversial. Therefore, we conducted a retrospective cohort study to analyze factors influencing the surgical risk of PD and to evaluate the role of biliary drainage therein. Methods: A retrospective analysis was performed on the clinical data of 354 patients with periampullary malignancies who underwent PD at Beijing Friendship Hospital, Capital Medical University, between June 2017 and October 2022. Through comprehensive scoring based on surgical approach, operative time, and intraoperative blood loss, we derived surgical risk scores and stratified patients into high-risk and low-risk groups. Variables including patient history, preoperative procedures, and laboratory and imaging findings were included in least absolute shrinkage and selection operator (LASSO) regression to identify variables at the optimal lambda value. These variables were then incorporated into binary multivariate logistic regression to analyze factors influencing the surgical risk of PD. Furthermore, we analyzed influencing factors specifically in patients who underwent PBD to identify risk factors affecting surgical risk in this subgroup. Results: A total of 354 patients were included in this study, with 195 cases stratified into the low-risk group and 159 cases assigned to the high-risk group. Among all 354 enrolled patients, 184 did not undergo PBD, while 170 underwent PBD. Analysis revealed that the biliary drainage group had a higher surgical risk compared to the non-drainage group [odds ratio (OR): 1.615; 95% confidence interval (CI): 1.020-2.556, P=0.04]. Further analysis of the impact of different biliary drainage methods on surgical difficulty showed that, among patients who underwent PBD, retrograde drainage was a risk factor for surgical risk (OR: 2.032; 95% CI: 1.016-4.064, P=0.045). Conclusions: PBD was identified as an independent risk factor for elevated surgical risk in PD. Among patients undergoing biliary drainage, retrograde drainage, compared to antegrade drainage, is an independent risk factor for surgical risk.
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