Skip to main content
SpringerLink
Log in

Role of Preoperative Biliary Stenting and Preoperative Preparation Before Pancreaticoduodenectomy

  • Chapter
  • First Online:
Surgery for Pancreatic and Periampullary Cancer

Abstract

Surgical resection remains the only potentially curative treatment option for patients diagnosed with pancreatic cancer. Pancreaticoduodenectomy is a morbid procedure that is fraught with an acceptable mortality rate, but a high morbidity rate. Preoperative biliary stenting can be used as a bridge to surgery for pancreatic cancer, to minimize the risk of developing cholangitis and to facilitate the administration of neoadjuvant therapy in patients with locally advanced pancreatic cancer. It can also be used for palliation in patients with unresectable disease. However, biliary stenting is not recommended for routine use preoperatively and must be individualized to the patient. Prior to pancreaticoduodenectomy, a thorough, systematic, and methodical approach to risk stratification and preoperative planning is mandatory to improve patient selection and optimize outcomes. A multidisciplinary team approach consisting of surgeons, gastroenterologists, medical oncologists, radiation oncologists, and pain specialists helps to deliver comprehensive care to patients in preparation for the operation.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin. 2016;66:7–30.

    Article  Google Scholar 

  2. Gong Z, Holly EA, Bracci PM. Survival in population-based pancreatic cancer patients: San Francisco Bay Area, 1995-1999. Am J Epidemiol. 2011;174:1373–81.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Grover S, Syngal S. Hereditary pancreatic cancer. Gastroenterology. 2010;139(4):1076–80, 1080.e1-2.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Cameron JL, He J. Two thousand consecutive pancreaticoduodenectomies. J Am Coll Surg. 2015;220:530–6.

    Article  PubMed  Google Scholar 

  5. Whipple AO, Parsons WB, Mullins CR. Treatment of carcinoma of the ampulla of Vater. Ann Surg. 1935;102(4):763–79.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Denning DA, Ellison EC, Carey LC. Preoperative percutaneous transhepatic biliary decompression lowers operative morbidity in patients with obstructive jaundice. Am J Surg. 1981;141:61–5.

    Article  CAS  PubMed  Google Scholar 

  7. Soehendra N, Reynders-Frederix V. Palliative bile duct drainage—a new endoscopic method of introducing a transpapillary drain. Endoscopy. 1980;12:8–11.

    Article  CAS  PubMed  Google Scholar 

  8. Green J, Beyar R, Bomzon L, Finberg JP, Better OS. Jaundice, the circulation and the kidney. Nephron. 1984;37:145–52.

    Article  CAS  PubMed  Google Scholar 

  9. Parks RW, Halliday MI, McCrory DC, Erwin P, Smye M, Diamond T, Rowlands BJ. Host immune responses and intestinal permeability in patients with jaundice. Br J Surg. 2003;90:239–45.

    Article  CAS  PubMed  Google Scholar 

  10. Rodarte-Shade M, Kahaleh M. Stent placement as a bridge to surgery in malignant biliary obstruction (pancreatic cancer, distal bile duct cancer, and hilar tumors). Gastrointest Interv. 2015;4:21–6.

    Article  Google Scholar 

  11. Nakayama T, Ikeda A, Okuda K. Percutaneous transhepatic drainage of the biliary tract. Technique and results in 104 cases. Gastroenterology. 1978;74:554–9.

    PubMed  CAS  Google Scholar 

  12. Gundry SR, Strodel WE, Knol JA, Eckhauser FE, Thompson NW. Efficacy of preoperative biliary tract decompression in patients with obstructive jaundice. Arch Surg. 1984;119:703–8.

    Article  CAS  PubMed  Google Scholar 

  13. Smith RC, Pooley M, George CRP, Faithful GR. Preoperative percutaneous transhepatic internal drainage in obstructive jaundice: a randomized, controlled trial examining renal function. Surgery. 1985;97:641–8.

    PubMed  CAS  Google Scholar 

  14. Robison R, Madura J, Scholten D, Lempke R, Rabe F, Glover J, Becker G, Cockerill E, Broadie T. Percutaneous transhepatic drainage for malignant biliary obstruction. Am Surg. 1984;50:329–33.

    PubMed  CAS  Google Scholar 

  15. Martignoni ME, Wagner M, Krähenbühl L, Redaelli CA, Friess H, Büchler MW. Effect of preoperative biliary drainage on surgical outcome after pancreatoduodenectomy. Am J Surg. 2001;181:52–9.

    Article  CAS  PubMed  Google Scholar 

  16. Sewnath ME, Birjmohun RS, Rauws EAJ, Huibregtse K, Obertop H, Gouma DJ. The effect of preoperative biliary drainage on postoperative complications after pancreaticoduodenectomy. J Am Coll Surg. 2001;192:726–34.

    Article  CAS  PubMed  Google Scholar 

  17. Van Der Gaag NA, De Castro SMM, Rauws EAJ, Bruno MJ, Van Eijck CHJ, Kuipers EJ, Gerritsen JJGM, Rutten J, Greve JW, Hesselink EJ, Klinkenbijl JHG, Rinkes IHMB, Boerma D, Bonsing BA, Van Laarhoven CJ, Kubben FJGM, Van Der Harst E, Sosef MN, Bosscha K, De Hingh IHJT, Th De Wit L, Van Delden OM, Busch ORC, Van Gulik TM, Bossuyt PMM, Gouma DJ. Preoperative biliary drainage for periampullary tumors causing obstructive jaundice; DRainage vs. (direct) OPeration (DROP-trial). BMC Surg. 2007;7:3.

    Article  PubMed  PubMed Central  Google Scholar 

  18. van dG, Rauws EAJ, van Eijck CHJ, Bruno MJ, van dH, Kubben FJGM, Gerritsen JJGM, Greve JW, Gerhards MF, de Hingh IHJT, Klinkenbijl JH, Nio CY, de Castro SMM, Busch ORC, van Gulik TM, Bossuyt PMM, Gouma DJ. Preoperative biliary drainage for cancer of the head of the pancreas. N Engl J Med. 2010;362:129–37.

    Article  Google Scholar 

  19. Baron TH, Kozarek RA. Preoperative biliary stents in pancreatic cancer—proceed with caution. N Engl J Med. 2010;362:170–2.

    Article  CAS  PubMed  Google Scholar 

  20. Moss AC, Morris E, Mac Mathuna P. Palliative biliary stents for obstructing pancreatic carcinoma. Cochrane Database Syst Rev. 25;(1):CD004200.

    Google Scholar 

  21. Tol JAMG, Van Hooft JE, Timmer R, Kubben FJGM, Van Der Harst E, De Hingh IHJT, Vleggaar FP, Molenaar IQ, Keulemans YCA, Boerma D, Bruno MJ, Schoon EJ, Van Der Gaag NA, Besselink MGH, Fockens P, Van Gulik TM, Rauws EAJ, Busch ORC, Gouma DJ. Metal or plastic stents for preoperative biliary drainage in resectable pancreatic cancer. Gut. 2016;65:1981–7.

    Article  CAS  PubMed  Google Scholar 

  22. Fang Y, Gurusamy KS, Wang Q, Davidson BR, Lin H, Xie X, Wang C. Pre-operative biliary drainage for obstructive jaundice. Cochrane Database Syst Rev. 2012;9.

    Google Scholar 

  23. Baron TH, Petersen BT, Mergener K, Chak A, Cohen J, Deal SE, Hoffinan B, Jacobson BC, Petrini JL, Safdi MA, Faigel DO, Pike IM. Quality indicators for endoscopic retrograde cholangiopancreatography. Am J Gastroenterol. 2006;101:892–7.

    Article  PubMed  Google Scholar 

  24. Cotton PB. Income and outcome metrics for the objective evaluation of ERCP and alternative methods. Gastrointest Endosc. 2002;56:S283–90.

    Article  PubMed  Google Scholar 

  25. Moss AC, Morris E, Leyden J, MacMathuna P. Malignant distal biliary obstruction: a systematic review and meta-analysis of endoscopic and surgical bypass results. Cancer Treat Rev. 2007;33:213–21.

    Article  PubMed  Google Scholar 

  26. Sawas T, Al Halabi S, Parsi MA, Vargo JJ. Self-expandable metal stents versus plastic stents for malignant biliary obstruction: a meta-analysis. Gastrointest Endosc. 2015;82:256–267.e7.

    Article  PubMed  Google Scholar 

  27. Lawrence C, Howell DA, Conklin DE, Stefan AM, Martin RF. Delayed pancreaticoduodenectomy for cancer patients with prior ERCP-placed, nonforeshortening, self-expanding metal stents: a positive outcome. Gastrointest Endosc. 2006;63:804–7.

    Article  PubMed  Google Scholar 

  28. Sun C, Yan G, Li Z, Tzeng C. A meta-analysis of the effect of preoperative biliary stenting on patients with obstructive jaundice. Medicine (Baltimore). 2014;93(26):e189.

    Article  Google Scholar 

  29. Loew BJ, Howell DA, Sanders MK, Desilets DJ, Kortan PP, May GR, Shah RJ, Chen YK, Parsons WG, Hawes RH, Cotton PB, Slivka AA, Ahmad J, Lehman GA, Sherman S, Neuhaus H, Schumacher BM. Comparative performance of uncoated, self-expanding metal biliary stents of different designs in 2 diameters: final results of an international multicenter, randomized, controlled trial. Gastrointest Endosc. 2009;70:445–53.

    Article  PubMed  Google Scholar 

  30. Yang KY, Ryu JK, Seo JK, Woo SM, Park JK, Kim Y, Yoon YB. A comparison of the Niti-D biliary uncovered stent and the uncovered Wallstent in malignant biliary obstruction. Gastrointest Endosc. 2009;70:45–51.

    Article  PubMed  Google Scholar 

  31. Yoon WJ, Ryu JK, Yang KY, Paik WH, Lee JK, Woo SM, Park JK, Kim Y, Yoon YB. A comparison of metal and plastic stents for the relief of jaundice in unresectable malignant biliary obstruction in Korea: an emphasis on cost-effectiveness in a country with a low ERCP cost. Gastrointest Endosc. 2009;70:284–9.

    Article  PubMed  Google Scholar 

  32. Dumonceau J, Tringali A, Blero D, Devière J, Laugiers R, Heresbach D, Costamagna G. Biliary stenting: indications, choice of stents and results: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline. 2012;44(03):277–98.

    Google Scholar 

  33. Inamdar S, Slattery E, Bhalla R, Sejpal DV, Trindade AJ. Comparison of adverse events for endoscopic vs percutaneous biliary drainage in the treatment of malignant biliary tract obstruction in an Inpatient National Cohort. JAMA Oncol. 2016;2:112–7.

    Article  PubMed  Google Scholar 

  34. Allen VB, Gurusamy KS, Takwoingi Y, Kalia A, Davidson BR. Diagnostic accuracy of laparoscopy following computed tomography (CT) scanning for assessing the resectability with curative intent in pancreatic and periampullary cancer. Cochrane Database Syst Rev. 2016;6;7:CD009323doi: https://doi.org/10.1002/14651858.CD009323.pub3.

  35. Liu RC, Traverso LW. Diagnostic laparoscopy improves staging of pancreatic cancer deemed locally unresectable by computed tomography. Surg Endosc. 2005;19:638–42.

    Article  CAS  PubMed  Google Scholar 

  36. Thomson BNJ, Parks RW, Redhead DN, Welsh FKS, Madhavan KK, Wigmore SJ, Garden OJ. Refining the role of laparoscopy and laparoscopic ultrasound in the staging of presumed pancreatic head and ampullary tumours. Br J Cancer. 2006;94:213–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Eagle KA, Berger PB, Calkins H, Chaitman BR, Ewy GA, Fleischmann KE, Fleisher LA, Froehlich JB, Gusberg RJ, Leppo JA, Ryan T, Schlant RC, Winters WL Jr, Gibbons RJ, Antman EM, Alpert JS, Faxon DP, Fuster V, Gregoratos G, Jacobs AK, Hiratzka LF, Russell RO, Smith SC Jr. ACC/AHA guideline update for perioperative cardiovascular evaluation for noncardiac surgery—executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) 123. J Am Coll Cardiol. 2002;39:542–53.

    Article  PubMed  Google Scholar 

  38. Eagle KA, Brundage BH, Chaitman BR, Ewy GA, Fleisher LA, Hertzer NR, Leppo JA, Ryan T, Schlant RC, Spencer WH III, Spittell JA Jr, Twiss RD, Ritchie JL, Cheitlin MD, Gardner TJ, Garson A Jr, Lewis RP, Gibbons RJ, O'Rourke RA, Ryan TJ. Guidelines for perioperative cardiovascular evaluation for noncardiac surgery: Report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). Circulation. 1996;93:1278–317.

    PubMed  CAS  Google Scholar 

  39. Grønkjær M, Eliasen M, Skov-Ettrup LS, Tolstrup JS, Christiansen AH, Mikkelsen SS, Becker U, Flensborg-Madsen T. Preoperative smoking status and postoperative complications: a systematic review and meta-analysis. Ann Surg. 2014;259:52–71.

    Article  PubMed  Google Scholar 

  40. Warner MA, Divertie MB, Tinker JH. Preoperative cessation of smoking and pulmonary complications in coronary artery bypass patients. Anesthesiology. 1984;60:380–3.

    Article  CAS  PubMed  Google Scholar 

  41. Sorensen LT, Karlsmark T, Gottrup F. Abstinence from smoking reduces incisional wound infection: a randomized controlled trial. Ann Surg. 2003;238:1–5.

    PubMed  PubMed Central  Google Scholar 

  42. Brooks-Brunn JA. Predictors of postoperative pulmonary complications following abdominal surgery. Chest. 1997;111:564–71.

    Article  CAS  PubMed  Google Scholar 

  43. McAlister FA, Khan NA, Straus SE, Papaioakim M, Fisher BW, Majumdar SR, Gajic O, Daniel M, Tomlinson G. Accuracy of the preoperative assessment in predicting pulmonary risk after nonthoracic surgery. Am J Respir Crit Care Med. 2003;167:741–4.

    Article  PubMed  Google Scholar 

  44. Lee TH, Marcantonio ER, Mangione CM, Thomas EJ, Polanczyk CA, Cook EF, Sugarbaker DJ, Donaldson MC, Poss R, Ho KKL, Ludwig LE, Pedan A, Goldman L. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 1999;100:1043–9.

    Article  CAS  Google Scholar 

  45. Devereaux PJ, Goldman L, Cook DJ, Gilbert K, Leslie K, Guyatt GH. Perioperative cardiac events in patients undergoing noncardiac surgery: a review of the magnitude of the problem, the pathophysiology of the events and methods to estimate and communicate risk. CMAJ. 2005;173:627–34.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Bilimoria KY, Liu Y, Paruch JL, Zhou L, Kmiecik TE, Ko CY, Cohen ME. Development and evaluation of the universal ACS NSQIP surgical risk calculator: a decision aid and informed consent tool for patients and surgeons. J Am Coll Surg. 2013;217(5):833–42.e1-3.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Are C, Afuh C, Ravipati L, Sasson A, Ullrich F, Smith L. Preoperative nomogram to predict risk of perioperative mortality following pancreatic resections for malignancy. J Gastrointest Surg. 2009;13:2152–62.

    Article  PubMed  Google Scholar 

  48. Berg J, Appelbaum P, Lidz C. Informed consent: legal theory and clinical practice. New York: Oxford University Press; 2001.

    Google Scholar 

  49. Perrenoud B, Velonaki V, Bodenmann P, Ramelet A. The effectiveness of health literacy interventions on the informed consent process of health care users: a systematic review protocol. JBI Database System Rev Implement Rep. 2015;13:82–94.

    Article  PubMed  Google Scholar 

  50. Lassen K, Coolsen MME, Slim K, Carli F, De Aguilar-Nascimento JE, Schäfer M, Parks RW, Fearon KCH, Lobo DN, Demartines N, Braga M, Ljungqvist O, Dejong CHC. Guidelines for perioperative care for pancreaticoduodenectomy: enhanced recovery after surgery (ERAS®) society recommendations. World J Surg. 2013;37:240–58.

    Article  PubMed  Google Scholar 

  51. Gärtner S, Krüger J, Aghdassi A. Nutrition in pancreatic cancer: a review. Gastrointest Tumors. 2016;2(4):195–202. https://doi.org/10.1159/000442873. Epub 2016 Jan 8.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  52. Davidson W, Ash S, Capra S, Bauer J, Fearon KCH, von Meyenfeldt MF, Roy A, Gouma DJ, Giacosa A, Van Gossum A, Ash S. Weight stabilisation is associated with improved survival duration and quality of life in unresectable pancreatic cancer. Clin Nutr. 2004;23:239–47.

    Article  PubMed  Google Scholar 

  53. Ferrucci LM, Bell D, Thornton J, Black G, McCorkle R, Heimburger DC, Saif MW. Nutritional status of patients with locally advanced pancreatic cancer: a pilot study. Support Care Cancer. 2011;19:1729–34.

    Article  PubMed  Google Scholar 

  54. Andersson R, Dervenis C, Haraldsen P, Leveau P. Nutritional aspects in the management of pancreatic cancer. Ann Gastroenterol. 2000;13:221–4.

    Google Scholar 

  55. Gould MK, Garcia DA, Wren SM, Karanicolas PJ, Arcelus JI, Heit JA, Samama CM. Prevention of VTE in nonorthopedic surgical patients. Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141:e227S–77S.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. Chew HK, Wun T, Harvey D, Zhou H, White RH. Incidence of venous thromboembolism and its effect on survival among patients with common cancers. Arch Intern Med. 2006;166:458–64.

    Article  PubMed  Google Scholar 

  57. Reinke CE, Drebin JA, Kreider S, Kean C, Resnick A, Raper S, Kelz RR. Timing of preoperative pharmacoprophylaxis for pancreatic surgery patients: a venous thromboembolism reduction initiative. Ann Surg Oncol. 2012;19:19–25.

    Article  PubMed  Google Scholar 

  58. Winter JM, Cameron JL, Campbell KA, Arnold MA, Chang DC, Coleman J, Hodgin MB, Sauter PK, Hruban RH, Riall TS, Schulick RD, Choti MA, Lillemoe KD, Yeo CJ. 1423 Pancreaticoduodenectomies for pancreatic cancer: a single-institution experience. J Gastrointest Surg. 2006;10:1199–211.

    Article  PubMed  Google Scholar 

  59. Shah BC, Smith LM, Ullrich F, Are C. Discharge disposition after pancreatic resection for malignancy: analysis of national trends. HPB (Oxford). 2012;14:201–8.

    Article  Google Scholar 

  60. Shah BC, Ullrich F, Smith L, Leiphrakpam P, Ly Q, Sasson A, Are C. National trends in discharge disposition after hepatic resection for malignancy. HPB (Oxford). 2011;13:96–102.

    Article  Google Scholar 

  61. Balcom JH IV, Rattner DW, Warshaw AL, Chang Y, Fernandez-Del Castillo C. Ten-year experience with 733 pancreatic resections: changing indications, older patients, and decreasing length of hospitalization. Arch Surg. 2001;136:391–8.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA

    Rishi Batra & Chandrakanth Are

Authors
  1. Rishi Batra
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chandrakanth Are
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chandrakanth Are .

Editor information

Editors and Affiliations

  1. Chief Hepato-Pancreato-Biliary and Gastrointestinal Division, Department of Surgical Oncology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, U.P., India

    Mallika Tewari

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Batra, R., Are, C. (2018). Role of Preoperative Biliary Stenting and Preoperative Preparation Before Pancreaticoduodenectomy. In: Tewari, M. (eds) Surgery for Pancreatic and Periampullary Cancer. Springer, Singapore. https://doi.org/10.1007/978-981-10-7464-6_5

Download citation

  • DOI: https://doi.org/10.1007/978-981-10-7464-6_5

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-10-7463-9

  • Online ISBN: 978-981-10-7464-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation