To evaluate the effect of preoperative biliary drainage (PBD) on postoperative complications in periampullary cancer patients undergoing pancreaticoduodenectomy (PD).

Clinical data of 84 patients with periampullary cancer who underwent PD in the First Affiliated Hospital of Xinjiang Medical University from January 2015 to December 2021 were retrospectively analyzed. Among them, 62 patients were male and 22 female, aged from 35 to 80 years, with a median age of 61 years. The informed consents of all patients were obtained and the local ethical committee approval was received. 36 patients did not receive PBD (non-PBD group), and 48 cases received PBD, including 24 cases in the endoscopic retrograde cholangiopancreatography (ERCP) group and 24 cases in the percutaneous transhepatic cholangial drainage (PTCD) group. Clinical data, postoperative complications, postoperative follow-up and survival were observed among three groups. The relationship between clinical data and postoperative complications was also analyzed. The incidence of postoperative complications was compared by Chi-square test, continuity correction Chi-square test or Fisher's exact test. Survival analysis was conducted by Kaplan-Meier method and Log-rank test.

The overall incidence of postoperative complications after PD was 37%(31/84), including 39%(14/36) in the non-PBD group, 42%(10/24) in the ERCP group and 29%(7/24) in the PTCD group, with no statistical significance (χ²=0.912, P>0.05). No postoperative death was reported in the ERCP group, 1 case in the PTCD group and 2 cases in the non-PBD group, respectively. No significant difference was found in the mortality rate among three groups (P=0.782). The median survival among the three groups was 13, 14 and 19 months, respectively, with no statistical significance (χ²=0.866, P>0.05). When preoperative TB level was >250 mmol/L, the incidence of postoperative complications in PD patients was increased significantly (χ²=3.939, P<0.05).

For periampullary cancer patients complicated with obstructive jaundice undergoing PD, when preoperative TB level exceeds 250 mmol/L, PBD can reduce the incidence of postoperative complications. Consequently, PBD is recommended. There is no significant difference in postoperative complications and outcomes among patients undergoing different patterns of PBD. PBD should not be adopted as routine preoperative preparations.