Ampullary carcinoma: Effect of preoperative biliary drainage on surgical outcome

Sheikh Anwar Abdullah, Tarun Gupta, Khairul Azhar Jaafar, Yaw Fui Alexander Chung, London Lucien Peng Jin Ooi, Steven Joseph Mesenas

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)2908-2912
Number of pages5
JournalWorld Journal of Gastroenterology
Volume15
Issue number23
DOIs
Publication statusPublished - 21 Jun 2009
Externally publishedYes

Fingerprint

Drainage
Carcinoma
Gastroparesis
Abdominal Abscess
Mortality
Wound Infection
Hemorrhage
Pancreatitis
Sepsis
Morbidity
Surgical Wound Infection
Survival
Endoscopic Retrograde Cholangiopancreatography
Singapore
Hospital Mortality
Tertiary Care Centers
General Hospitals
Blood Transfusion
Hemoglobins
Demography

Keywords

  • Ampullary carcinoma
  • Postoperative complications
  • Preoperative biliary drainage

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Abdullah, S. A., Gupta, T., Jaafar, K. A., Chung, Y. F. A., Ooi, L. L. P. J., & Mesenas, S. J. (2009). Ampullary carcinoma: Effect of preoperative biliary drainage on surgical outcome. World Journal of Gastroenterology, 15(23), 2908-2912. https://doi.org/10.3748/wjg.15.2908

Ampullary carcinoma : Effect of preoperative biliary drainage on surgical outcome. / Abdullah, Sheikh Anwar; Gupta, Tarun; Jaafar, Khairul Azhar; Chung, Yaw Fui Alexander; Ooi, London Lucien Peng Jin; Mesenas, Steven Joseph.

In: World Journal of Gastroenterology, Vol. 15, No. 23, 21.06.2009, p. 2908-2912.

Research output: Contribution to journalArticle

Abdullah, SA, Gupta, T, Jaafar, KA, Chung, YFA, Ooi, LLPJ & Mesenas, SJ 2009, 'Ampullary carcinoma: Effect of preoperative biliary drainage on surgical outcome', World Journal of Gastroenterology, vol. 15, no. 23, pp. 2908-2912. https://doi.org/10.3748/wjg.15.2908
Abdullah SA, Gupta T, Jaafar KA, Chung YFA, Ooi LLPJ, Mesenas SJ. Ampullary carcinoma: Effect of preoperative biliary drainage on surgical outcome. World Journal of Gastroenterology. 2009 Jun 21;15(23):2908-2912. https://doi.org/10.3748/wjg.15.2908
Abdullah, Sheikh Anwar ; Gupta, Tarun ; Jaafar, Khairul Azhar ; Chung, Yaw Fui Alexander ; Ooi, London Lucien Peng Jin ; Mesenas, Steven Joseph. / Ampullary carcinoma : Effect of preoperative biliary drainage on surgical outcome. In: World Journal of Gastroenterology. 2009 ; Vol. 15, No. 23. pp. 2908-2912.
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abstract = "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.",
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N2 - 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.

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