RELATIONSHIP BETWEEN TIMING OF SURGERY AFTER PREOPERATIVE BILIARY DRAINAGE AND OUTCOMES FOLLOWING PANCREATODUODENECTOMY Relação entre o intervalo da drenagem biliar pré-operatória à cirurgia e os desfechos após pancreatoduodenectomia
- 1Universidade Estadual de Campinas (UNICAMP), Faculdade de Ciências Médicas, Departamento de Cirurgia, Campinas, SP, Brasil.
Abstract
Background: : The role and optimal timing of surgery following preoperative biliary drainage (PBD) in patients undergoing pancreatoduodenectomy remain controversial. Early surgery may be influenced by procedure-related inflammation, whereas delayed intervention may increase infectious complications due to biliary colonization.
Objective: : To evaluate the impact of the interval between biliary drainage and pancreatoduodenectomy on postoperative outcomes and its association with biliary contamination.
Methods: : This retrospective cohort study included 239 patients undergoing pancreatoduodenectomy between 2013 and 2025. Of these, 174 (73%) underwent PBD via endoscopic retrograde cholangiopancreatography. Patients were stratified by interval between drainage and surgery: ≤2 weeks, 3-6 weeks, and >6 weeks. The primary outcome was 90-day mortality; secondary outcomes included major complications (Clavien-Dindo ≥III). Multivariable logistic regression adjusted for confounders.
Results: : Surgery at 3-6 weeks was associated with the lowest rates of major complications (31.7%) and 90-day mortality (9.7%), compared with ≤2 weeks (57.1%; 28.6%) and >6 weeks (40.6%; 23.2%). Surgery outside this interval increased 90-day mortality risk (OR 2.9, 95%CI 1.07-7.83). Biliary colonization rose with longer intervals, exceeding 90% after three weeks.
Conclusion: : A 3-6 week interval between biliary drainage and pancreatoduodenectomy is associated with improved outcomes, suggesting an optimal window balancing inflammation and bacterial colonization.
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BibTeX
@article{tafner2026relationship,
title = {{RELATIONSHIP BETWEEN TIMING OF SURGERY AFTER PREOPERATIVE BILIARY DRAINAGE AND OUTCOMES FOLLOWING PANCREATODUODENECTOMY Relação entre o intervalo da drenagem biliar pré-operatória à cirurgia e os desfechos após pancreatoduodenectomia}},
author = {Philipe Franco do Amaral TAFNER and Bruna Mattos Vanetti de ALBUQUERQUE and Fernando Girardi da SILVA and Martinho Antonio GESTIC and Murillo Pimentel UTRINI and Francisco CALLEJAS-NETO and Everton CAZZO},
journal = {Arquivos de gastroenterologia},
year = {2026},
month = oct,
doi = {10.1590/s0004-2803.24612026-050},
url = {https://europepmc.org/article/PMC/PMC13722407},
note = {CC BY},
}
RIS
TY - JOUR
TI - RELATIONSHIP BETWEEN TIMING OF SURGERY AFTER PREOPERATIVE BILIARY DRAINAGE AND OUTCOMES FOLLOWING PANCREATODUODENECTOMY Relação entre o intervalo da drenagem biliar pré-operatória à cirurgia e os desfechos após pancreatoduodenectomia
AU - Philipe Franco do Amaral TAFNER
AU - Bruna Mattos Vanetti de ALBUQUERQUE
AU - Fernando Girardi da SILVA
AU - Martinho Antonio GESTIC
AU - Murillo Pimentel UTRINI
AU - Francisco CALLEJAS-NETO
AU - Everton CAZZO
PY - 2026
DA - 2026/10/30
JO - Arquivos de gastroenterologia
DO - 10.1590/s0004-2803.24612026-050
UR - https://europepmc.org/article/PMC/PMC13722407
AB - Background: : The role and optimal timing of surgery following preoperative biliary drainage (PBD) in patients undergoing pancreatoduodenectomy remain controversial. Early surgery may be influenced by procedure-related inflammation, whereas delayed intervention may increase infectious complications due to biliary colonization. Objective: : To evaluate the impact of the interval between biliary drainage and pancreatoduodenectomy on postoperative outcomes and its association with biliary contamination. Methods: : This retrospective cohort study included 239 patients undergoing pancreatoduodenectomy between 2013 and 2025. Of these, 174 (73%) underwent PBD via endoscopic retrograde cholangiopancreatography. Patients were stratified by interval between drainage and surgery: ≤2 weeks, 3-6 weeks, and >6 weeks. The primary outcome was 90-day mortality; secondary outcomes included major complications (Clavien-Dindo ≥III). Multivariable logistic regression adjusted for confounders. Results: : Surgery at 3-6 weeks was associated with the lowest rates of major complications (31.7%) and 90-day mortality (9.7%), compared with ≤2 weeks (57.1%; 28.6%) and >6 weeks (40.6%; 23.2%). Surgery outside this interval increased 90-day mortality risk (OR 2.9, 95%CI 1.07-7.83). Biliary colonization rose with longer intervals, exceeding 90% after three weeks. Conclusion: : A 3-6 week interval between biliary drainage and pancreatoduodenectomy is associated with improved outcomes, suggesting an optimal window balancing inflammation and bacterial colonization.
SN - 0004-2803
SN - 1678-4219
ER -