Ampullary carcinoma: effect of preoperative biliary drainage on surgical outcome

AIM: To evaluate the influence of preoperative biliary drainage on morbidity and mortality after surgical resection for ampullary carcinoma. METHODS: We analyzed retrospectively data for 82 patients who underwent potentially curative surgery for ampullary carcinoma between September 1993 and July 2...

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Main Authors:	Abdullah, Sheikh Anwar, Gupta, Tarun, Jaafar, Khairul Azhar, Chung, Yaw Fui Alexander, Mesenas, Steven Joseph, London, Lucien Peng Jin Ooi
Format:	Article
Language:	English
Published:	Baishideng Publishing Group 2009
Subjects:	RC Internal medicine RD Surgery
Online Access:	http://irep.iium.edu.my/12580/ http://irep.iium.edu.my/12580/ http://irep.iium.edu.my/12580/ http://irep.iium.edu.my/12580/1/WJG-15-2908.pdf

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spelling	iium-125802011-12-28T23:34:16Z http://irep.iium.edu.my/12580/ Ampullary carcinoma: effect of preoperative biliary drainage on surgical outcome Abdullah, Sheikh Anwar Gupta, Tarun Jaafar, Khairul Azhar Chung, Yaw Fui Alexander Mesenas, Steven Joseph London, Lucien Peng Jin Ooi RC Internal medicine RD Surgery AIM: To evaluate the influence of preoperative biliary drainage on morbidity and mortality after surgical resection for ampullary carcinoma. METHODS: We analyzed retrospectively data for 82 patients who underwent potentially curative surgery for ampullary carcinoma between September 1993 and July 2007 at the Singapore General Hospital, a tertiary referral hospital. Diagnosis of ampullary carcinoma was confirmed histologically. Thirty-five patients underwent preoperative biliary drainage (PBD group), and 47 were not drained (non-PBD group). The mode of biliary drainage was endoscopic retrograde cholangiopancreatography (n = 33) or percutaneous biliary drainage (n = 2). The following parameters were analyzed: wound infection, intra-abdominal abscess, intra-abdominal or gastrointestinal bleeding, septicemia, biliary or pancreatic leakage, pancreatitis, gastroparesis, and re-operation rate. Mortality was assessed at 30 d (hospital mortality) and also long-term. The statistical endpoint of this study was patient survival after surgery. RESULTS: The groups were well matched for demographic criteria, clinical presentation and operative characteristics, except for lower hemoglobin in the non-PBD group (10.9 ± 1.6 vs 11.8 ± 1.6 in the PBD group). Of the parameters assessing postoperative morbidity, incidence of wound infection was significantly less in the PBD than the non-PBD group [1 (2.9%) vs 12 (25.5%)]. However, the rest of the parameters did not differ significantly between the groups, i.e. sepsis [10 (28.6%) vs 14 (29.8%)], intra-abdominal bleeding [1 (2.9%) vs 5 (10.6%)], intra-abdominal abscess [1 (2.9%) vs 8 (17%)], gastrointestinal bleeding [3 (8.6%) vs 5 (10.6%)], pancreatic leakage [2 (5.7%) vs 3 (6.4%)], biliary leakage [2 (5.7%) vs 3 (6.4%)], pancreatitis [2 (5.7%) vs 2 (4.3%)], gastroparesis [6 (17.1%) vs 10 (21.3%)], need for blood transfusion [10 (28.6%) vs 17 (36.2%)] and re-operation rate [1 (2.9%) vs 5 (10.6%)]. There was no early mortality in either group. Median survival was 44 mo (95% CI: 34.2-53.8) in the PBD group and 41 mo (95% CI: 27.7-54.3; P = 0.86) in the non-PBD group. CONCLUSION: Biliary drainage before surgery for ampullary cancer significantly reduced postoperative wound infection. Overall mortality was not influenced by preoperative drainage. Baishideng Publishing Group 2009-06-21 Article PeerReviewed application/pdf en http://irep.iium.edu.my/12580/1/WJG-15-2908.pdf Abdullah, Sheikh Anwar and Gupta, Tarun and Jaafar, Khairul Azhar and Chung, Yaw Fui Alexander and Mesenas, Steven Joseph and London, Lucien Peng Jin Ooi (2009) Ampullary carcinoma: effect of preoperative biliary drainage on surgical outcome. World Journal of Gastroenterology (WJG), 15 (23). pp. 2908-2912. ISSN 1007-9327 http://www.wjgnet.com/1007-9327/15/2908.asp 10.3748/wjg.15.2908
repository_type	Digital Repository
institution_category	Local University
institution	International Islamic University Malaysia
building	IIUM Repository
collection	Online Access
language	English
topic	RC Internal medicine RD Surgery
spellingShingle	RC Internal medicine RD Surgery Abdullah, Sheikh Anwar Gupta, Tarun Jaafar, Khairul Azhar Chung, Yaw Fui Alexander Mesenas, Steven Joseph London, Lucien Peng Jin Ooi Ampullary carcinoma: effect of preoperative biliary drainage on surgical outcome
description	AIM: To evaluate the influence of preoperative biliary drainage on morbidity and mortality after surgical resection for ampullary carcinoma. METHODS: We analyzed retrospectively data for 82 patients who underwent potentially curative surgery for ampullary carcinoma between September 1993 and July 2007 at the Singapore General Hospital, a tertiary referral hospital. Diagnosis of ampullary carcinoma was confirmed histologically. Thirty-five patients underwent preoperative biliary drainage (PBD group), and 47 were not drained (non-PBD group). The mode of biliary drainage was endoscopic retrograde cholangiopancreatography (n = 33) or percutaneous biliary drainage (n = 2). The following parameters were analyzed: wound infection, intra-abdominal abscess, intra-abdominal or gastrointestinal bleeding, septicemia, biliary or pancreatic leakage, pancreatitis, gastroparesis, and re-operation rate. Mortality was assessed at 30 d (hospital mortality) and also long-term. The statistical endpoint of this study was patient survival after surgery. RESULTS: The groups were well matched for demographic criteria, clinical presentation and operative characteristics, except for lower hemoglobin in the non-PBD group (10.9 ± 1.6 vs 11.8 ± 1.6 in the PBD group). Of the parameters assessing postoperative morbidity, incidence of wound infection was significantly less in the PBD than the non-PBD group [1 (2.9%) vs 12 (25.5%)]. However, the rest of the parameters did not differ significantly between the groups, i.e. sepsis [10 (28.6%) vs 14 (29.8%)], intra-abdominal bleeding [1 (2.9%) vs 5 (10.6%)], intra-abdominal abscess [1 (2.9%) vs 8 (17%)], gastrointestinal bleeding [3 (8.6%) vs 5 (10.6%)], pancreatic leakage [2 (5.7%) vs 3 (6.4%)], biliary leakage [2 (5.7%) vs 3 (6.4%)], pancreatitis [2 (5.7%) vs 2 (4.3%)], gastroparesis [6 (17.1%) vs 10 (21.3%)], need for blood transfusion [10 (28.6%) vs 17 (36.2%)] and re-operation rate [1 (2.9%) vs 5 (10.6%)]. There was no early mortality in either group. Median survival was 44 mo (95% CI: 34.2-53.8) in the PBD group and 41 mo (95% CI: 27.7-54.3; P = 0.86) in the non-PBD group. CONCLUSION: Biliary drainage before surgery for ampullary cancer significantly reduced postoperative wound infection. Overall mortality was not influenced by preoperative drainage.
format	Article
author	Abdullah, Sheikh Anwar Gupta, Tarun Jaafar, Khairul Azhar Chung, Yaw Fui Alexander Mesenas, Steven Joseph London, Lucien Peng Jin Ooi
author_facet	Abdullah, Sheikh Anwar Gupta, Tarun Jaafar, Khairul Azhar Chung, Yaw Fui Alexander Mesenas, Steven Joseph London, Lucien Peng Jin Ooi
author_sort	Abdullah, Sheikh Anwar
title	Ampullary carcinoma: effect of preoperative biliary drainage on surgical outcome
title_short	Ampullary carcinoma: effect of preoperative biliary drainage on surgical outcome
title_full	Ampullary carcinoma: effect of preoperative biliary drainage on surgical outcome
title_fullStr	Ampullary carcinoma: effect of preoperative biliary drainage on surgical outcome
title_full_unstemmed	Ampullary carcinoma: effect of preoperative biliary drainage on surgical outcome
title_sort	ampullary carcinoma: effect of preoperative biliary drainage on surgical outcome
publisher	Baishideng Publishing Group
publishDate	2009
url	http://irep.iium.edu.my/12580/ http://irep.iium.edu.my/12580/ http://irep.iium.edu.my/12580/ http://irep.iium.edu.my/12580/1/WJG-15-2908.pdf
first_indexed	2023-09-18T20:21:45Z
last_indexed	2023-09-18T20:21:45Z
_version_	1777408153091047424

Ampullary carcinoma: effect of preoperative biliary drainage on surgical outcome

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