Assessment of Risk Factors for Adverse Treatment Outcomes and their Impact on Survival in Patients with Resectable Pancreatobiliary Tumors Complicated by Obstructive Jaundice
Introduction. Preoperative biliary decompression (PBD) happening in patients with malignant obstructive jaundice (MOJ) remains one of the main topics for discussion in recent years; given the advantages and disadvantages of this method of treatment, its impact on patient life expectancy and postoperative complications. Purpose. Identify risk factors and confirm their impact on PBD on the incidence of early postoperative complications and overall survival of patients with MOJ. Materials and methods. The one-center retrospective non-randomized cohort study of 136 patients with MOJ was performed. Inclusion criteria: patients with resectable tumors of the pancreatobiliary region, complicated by MOJ. All patients were divided into two groups, comparable in diagnosis and type of surgery and differing in the presence or absence of PBD. Group A - 84 patients with PBD, group B - 52 patients without PBD. All patients were treated at the clinical hospital of the Department of General Surgery № 1, Bogomolets National Medical University from 2016-2021 period of time. The median follow-up for each patient was 24.5 months (9.5-43.5 Q1-Q3). The end point of the study was an unfavorable clinical outcome (death of the patient) during the specified observation period. Overall survival was calculated by the Kaplan - Meier method and compared by log-rank test. One-factor and multifactorial Cox regression analysis was used to identify prognostic factors influencing treatment outcome and survival. Results. The survival of patients with PBD did not differ statistically from the group of patients without PBD (median survival 23 versus 21 months, p=0.48). Risk factors influencing the level of survival in both one-way and multifactorial Cox’s analysis revealed: hyperbilirubinemia >250 μmol/l, HR 1.0 (1.0-1.01 95% CI), p=0,02; prolonged jaundice until hospitalization (more than 20 days), HR 1.1 (1.03-1.18 95% CI), p=0.003; confirmed cholangitis at the time of PBD, HR 0.07 (0.03-0.1 95% CI), p<0.001; delay of surgical treatment after PBD >3 weeks, which was due to hepatic insufficiency, HR 5.27 (1.37-20.2 95% CI), p=0,01; the presence of postoperative complications, HR 0.14 (0.07-0.29 95% CI), p<0,001. Conclusions. PBD does not worsen the survival of patients with MOJ compared with patients in the group without biliary decompression. Planning PBD with clear indications is an important step in the treatment of patients with MOJ. Preoperative cholangitis is a major risk factor influencing the incidence of early postoperative complications and patient survival.