Effect of preoperative biliary drainage on pancreaticoduodenectomy in patients with low-level malignant obstructive jaundice

Objective: To investigate the effect of preoperative biliary drainage (PBD) on outcomes of pancreaticoduodenectomy (PD) in patients with low-level malignant obstructive jaundice. Methods: A retrospective analysis was conducted on patients who underwent PD due to low-level malignant obstructive jaundice at the Affiliated Hospital of North Sichuan Medical College and Nanchong Central Hospital between 1 January 2021, and 30 August 2024. Eligible patients had total serum bilirubin levels ≥171 μmol/L at the time of admission. Based on whether PBD was performed prior to surgery, patients were categorized into the PBD group and the direct surgery group. In the PBD group, clinical indicators before drainage (at admission) and after drainage (preoperatively) were compared to assess the effectiveness of jaundice reduction. Perioperative outcomes were compared between the two groups. Additionally, Kaplan–Meier survival analysis was used to evaluate the effect of PBD on perioperative outcomes and postoperative survival. Results: In the drainage group, significant improvements were observed in total bilirubin, direct bilirubin, alanine aminotransferase (ALT), and aspartate aminotransferase (AST) levels after biliary drainage (P < 0.05). There were no significant differences between the two groups in terms of operative time, intraoperative blood loss, postoperative ICU transfer, reoperation rate, length of postoperative hospital stay, incidence of major complications (pancreatic fistula, bile leak, hemorrhage, intra-abdominal infection, delayed gastric emptying), or 30-day mortality (all P > 0.05). However, significant differences were found in the total complication rate, preoperative preparation time, and total hospitalization costs (all P < 0.05). Postoperative survival did not differ significantly between the two groups (P > 0.05). Conclusion: Preoperative biliary drainage can effectively improve liver function in patients with low-level malignant obstructive jaundice. It is associated with a reduced overall incidence of postoperative complications following PD. While PBD may have a potential positive impact on postoperative survival, further large-scale studies are warranted to validate these findings.