The impact of preoperative biliary drainage on postoperative outcomes in patients with malignant obstructive jaundice: a retrospective analysis of 290 consecutive cases at a single medical center

Background The efficacy of preoperative biliary drainage (PBD) has been debated for several decades, and yet indications for PBD remain controversial. The aim of this study was to compare the postoperative morbidity and mortality in patients with malignant obstructive jaundice undergoing direct surgery versus surgery with PBD. Methods All consecutive patients with malignant obstructive jaundice who underwent radical resection between June 2017 and December 2019 at Zhongshan Hospital were analyzed retrospectively. The study population was divided into two groups: PBD group (PG) and direct surgery group (DG). The subgroups were chosen based on the site of obstruction. Perioperative indicators and postoperative complications were compared and analyzed. Results A total of 290 patients were analyzed. Postoperative complications occurred in 134 patients (46.4%). Patients in the PG group had a lower overall rate of postoperative complications compared with the DG group, with perioperative total bilirubin (TB) identified as an independent risk factor in multivariate analysis (hazard ratio = 1.004; 95% confidence interval 1.001–1.007; P = 0.017). Subgroup analysis showed that PBD reduced the complication rate in patients with proximal obstruction. In the proximal-obstruction subgroup, a preoperative TB level > 162 μmol/L predicted postoperative complications. Conclusions PBD may reduce the overall rate of postoperative complications among patients with proximal malignant obstructive jaundice. Trial registration ClinicalTrials.gov, 2018ZSLC 24. Registered May 17, 2018, https://clinicaltrials.gov/.

A Predictive Model Based on the Gut Microbiota Improves the Diagnostic Effect in Patients With Cholangiocarcinoma

Cholangiocarcinoma (CCA) is a malignant hepatic tumor with a poor prognosis, which needs early diagnosis urgently. The gut microbiota has been shown to play a crucial role in the progression of liver cancer. Here, we explored a gut microbiota model covering genera Burkholderia-Caballeronia-Paraburkholderia, Faecalibacterium, and Ruminococcus_1 (B-F-R) for CCA early diagnosis. A case-control study was conducted to enroll 53 CCA patients, 47 cholelithiasis patients, and 40 healthy controls. The feces samples and clinical information of participants were collected in the same period. The gut microbiota and its diversity of individuals were accessed with 16S rDNA sequencing, and the gut microbiota profile was evaluated according to microbiota diversity. Finally, four enriched genera in the CCA group (genera Bacteroides, Muribaculaceae_unclassified, Muribaculum, and Alistipes) and eight enriched genera in the cholelithiasis group (genera Bifidobacterium, Streptococcus, Agathobacter, Ruminococcus_gnavus_group, Faecalibacterium, Subdoligranulum, Collinsella, Escherichia-Shigella) constitute an overall different microbial community composition (P = 0.001). The B-F-R genera model with better diagnostic value than carbohydrate antigen 19-9 (CA19-9) was identified by random forest and Statistical Analysis of Metagenomic Profiles (STAMP) to distinguish CCA patients from healthy controls [area under the curve (AUC) = 0.973, 95% CI = 0.932–1.0]. Moreover, the correlative analysis found that genera Burkholderia-Caballeronia-Paraburkholderia were positively correlated with body mass index (BMI). The significantly different microbiomes between cholelithiasis and CCA were found via principal coordinates analysis (PCoA) and linear discriminant analysis effect size (LEfSe), and Venn diagram and LEfSe were utilized to identify four genera by comparing microbial compositions among patients with malignant obstructive jaundice (MOJ-Y) or not (MOJ-N). In brief, our findings suggest that gut microbiota vary from benign and malignant hepatobiliary diseases to healthy people and provide evidence supporting gut microbiota to be a non-invasive biomarker for the early diagnosis of CCA.

Comparison among the Role of Different Imaging Techniques in Diagnosis of Malignant Lesions Causing Obstructive Jaundice

Introduction: The expanding spectrum of therapeutic options for patients with Obstructive /surgical jaundice makes it necessary for the surgeon to precisely assess the etiology, location, level and extent of disease before operation. Aims were to compare the diagnostic accuracy, sensitivity and specificity of different imaging techniques like ultrasonography (USG), Computed tomography (CT) and Magnetic Resonance Cholangiopancreatography (MRCP) and Endoscopic Retrograde Cholangiopancreatography (ERCP) in evaluation of patients with malignant obstructive jaundice and correlation of histopathological findings after surgical/ therapeutic intervention. Methods: It was a prospective observational study conducted in the Department of General Surgery and Hepatobilliary unit, Dhaka Medical College Hospital and Bangabandhu Sheikh Mujib Medical University, Dhaka during January 2015 to December 2015 for duration of one year to find out the role of different imaging techniques in diagnosis of malignant lesions causing obstructive jaundice in 50 cases who fulfilled the inclusion criteria. Initial USG evaluation was followed by CT scan, MRCP and ERCP. The results were read by radiologists blinded to other imaging findings. Surgically fit patients with a stage of resectability should be offered the option of surgical resection for cure. For unresectable malignancies, the choice is between surgical palliation/bypass and ERCP with drainage. The characteristic surgical findings or ERCP features and histopathological diagnosis were recorded methodically as final. Results: Malignant obstructive jaundice is the commonest amongst the males and mean age was 47.56 ± 13.191 and the commonest etiology was Ca head of pancreas (30%). Diagnostic accuracy of MRCP (98%) in the diagnosis of malignant obstructive jaundice was relatively high (98%) as compared to ERCP (89.5%), CT (91.43%), USG (89.97%) in malignant obstructive jaundice respectively. In the diagnosis of malignant diseases, MRCP was more sensitive (95.83%) as compared to ERCP (89%), CT scan (91.67%) and ultrasonography (78.17%). Regarding specificity MRCP (100%) was the high in comparison among ERCP (94%), CT (90.91%) and USG (96.15%).Conclusion: It is concluded that malignant obstructive jaundice is the commonest amongst the males. Ca head of pancreas was the commonest malignant etiology in malignant obstructive jaundice. MRCP was superior to among USG, CT scan or ERCP in studying the malignant lesions. J Bangladesh Coll Phys Surg 2021; 39: 233-240