Delaying surgery after preoperative biliary drainage does not increase surgical morbidity after pancreaticoduodenectomy

Background: The effects of the time interval from preoperative biliary drainage to pancreaticoduodenectomy on morbidity and mortality have not been established, but a recent multicenter study found that an interval greater than 4 weeks resulted in fewer major complications. We investigated whether delaying pancreaticoduodenectomy after preoperative biliary drainage led to improved postoperative morbidity and mortality. Methods: Patients who underwent elective open pancreaticoduodenectomy between January 2009 and December 2016 were retrospectively analyzed. They were divided into a short duration group (time interval to surgery <4 weeks) and a delaying surgery group (time interval to surgery >= 4 weeks). An unstented control group (no stent group) was added. Perioperative characteristics and surgical outcomes were compared. Results: Of 603 patients who underwent pancreaticoduodenectomy, 183 (30.3%) had preoperative biliary drainage, 110 patients (18.2%) in the short duration group and 73 (12.1%) in the delaying surgery group. The median interval between preoperative biliary drainage and pancreaticoduodenectomy was 3 weeks (interquartile range, 2-3) for the former group and 6 weeks (interquartile range, 5-7) for the latter. With the exception of wound infection, which was significantly higher in the short duration group than in the controls (8.2% vs 1.7%, P = .002) but not significantly increased compared with the delaying surgery group (8.2% vs 4.1%, P = .368), other complications were comparable among the 3 groups. Subgroup analyses in the intermediate- and high-risk cohort based on either original or alternative Fistula Risk Score showed similar outcomes. Univariate and multivariate analyses showed that short stent duration and female sex were independent factors associated with wound infection. Conclusion: A time interval between preoperative biliary drainage and resection greater than 4 weeks does not have a negative impact on short-term surgical outcomes. This finding indicates the relative safety of postponing surgery, if necessary, for preoperative treatment, optimization, or preparation. (C) 2019 Elsevier Inc. All rights reserved.