Robotic pancreaticoduodenectomy provides better histopathological outcomes as compared to its open counterpart: a meta-analysis

AbstractThe aim of this meta-analysis was to evaluate whether robotic pancreaticoduodenectomy (PD) may provide better clinical and pathologic outcomes compared to its open counterpart. The Pubmed, EMBASE, and Cochrane Library were systematically searched. Overall postoperative morbidity and resection margin involvement rate were the primary endpoints. Secondary endpoints included operating time, estimated blood loss (EBL), incisional surgical site infection (SSI) rate, length of hospital stay (LOS), and number of lymph nodes harvested. Twenty-four studies totaling 12,579 patients (2,175 robotic PD and 10,404 open PD were included. Overall postoperative mortality did not significantly differ [OR (95%CI) = 0.86 (0.74, 1.01); p = 0.06]. Resection margin involvement rate was significantly lower in robotic PD [15.6% vs. 19.9%; OR (95%CI) = 0.64 (0.41, 1.00); p = 0.05; NNT = 23]. Operating time was significantly longer in robotic PD [MD (95%CI) = 75.17 (48.05, 102.28); p < 0.00001]. EBL was significantly decreased in robotic PD [MD (95%CI) = − 191.35 (− 238.12, − 144.59); p < 0.00001]. Number of lymph nodes harvested was significantly higher in robotic PD [MD (95%CI) = 2.88 (1.12, 4.65); p = 0.001]. This meta-analysis found that robotic PD provides better histopathological outcomes as compared to open PD at the cost of longer operating time. Furthermore, robotic PD did not have any detrimental impact on clinical outcomes, with lower wound infection rates.

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Systematic review and updated network meta-analysis comparing open, laparoscopic, and robotic pancreaticoduodenectomy

Updates in Surgery ◽

10.1007/s13304-020-00916-1 ◽

2020 ◽

Author(s):

Alberto Aiolfi ◽

Francesca Lombardo ◽

Gianluca Bonitta ◽

Piergiorgio Danelli ◽

Davide Bona

Keyword(s):

Minimally Invasive ◽

Hospital Readmission ◽

Meta Analysis ◽

Postoperative Bleeding ◽

Pancreatic Head ◽

Postoperative Mortality ◽

Hospital Length Of Stay ◽

Oncologic Outcomes ◽

Estimated Blood Loss ◽

Robotic Pancreaticoduodenectomy

AbstractThe treatment of periampullary and pancreatic head neoplasms is evolving. While minimally invasive Pancreaticoduodenectomy (PD) has gained worldwide interest, there has been a debate on its related outcomes. The purpose of this paper was to provide an updated evidence comparing short-term surgical and oncologic outcomes within Open Pancreaticoduodenectomy (OpenPD), Laparoscopic Pancreaticoduodenectomy (LapPD), and Robotic Pancreaticoduodenectomy (RobPD). MEDLINE, Web of Science, PubMed, Cochrane Central Library, and ClinicalTrials.gov were referred for systematic search. A Bayesian network meta-analysis was executed. Forty-one articles (56,440 patients) were included; 48,382 (85.7%) underwent OpenPD, 5570 (9.8%) LapPD, and 2488 (4.5%) RobPD. Compared to OpenPD, LapPD and RobPD had similar postoperative mortality [Risk Ratio (RR) = 1.26; 95%CrI 0.91–1.61 and RR = 0.78; 95%CrI 0.54–1.12)], clinically relevant (grade B/C) postoperative pancreatic fistula (POPF) (RR = 1.12; 95%CrI 0.82–1.43 and RR = 0.87; 95%CrI 0.64–1.14, respectively), and severe (Clavien-Dindo ≥ 3) postoperative complications (RR = 1.03; 95%CrI 0.80–1.46 and RR = 0.93; 95%CrI 0.65–1.14, respectively). Compared to OpenPD, both LapPD and RobPD had significantly reduced hospital length-of-stay, estimated blood loss, infectious, pulmonary, overall complications, postoperative bleeding, and hospital readmission. No differences were found in the number of retrieved lymph nodes and R0. OpenPD, LapPD, and RobPD seem to be comparable across clinically relevant POPF, severe complications, postoperative mortality, retrieved lymphnodes, and R0. LapPD and RobPD appears to be safer in terms of infectious, pulmonary, and overall complications with reduced hospital readmission We advocate surgeons to choose their preferred surgical approach according to their expertise, however, the adoption of minimally invasive techniques may possibly improve patients’ outcomes.

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Efficiency of complete omentectomy in patients with resectable gastric cancer: a meta‑analysis and systematic review

BMC Gastroenterology ◽

10.1186/s12876-021-01921-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Akao Zhu ◽

Guang Yin ◽

Xinchun Liu ◽

Wencheng Kong ◽

Yu Zhang ◽

...

Keyword(s):

Gastric Cancer ◽

Blood Loss ◽

Lymph Nodes ◽

Meta Analysis ◽

Cochrane Library ◽

Significant Heterogeneity ◽

Recurrence Rates ◽

Estimated Blood Loss ◽

Significant Difference ◽

Hospital Stays

Abstract Background We performed a meta-analysis to investigate the efficacy of complete omentectomy (CO) in patients undergoing radical gastrectomy for gastric cancer. Methods We conducted a literature search in PubMed, Web of Science, and the Cochrane Library databases for clinical research that compared CO with non-complete omentectomy (NCO). These articles were published prior to April 2021. Overall survival (OS) rates, relapse-free survival (RFS) rates, recurrence rates, operation times, estimates of blood loss, numbers of harvested lymph nodes, complications, and lengths of hospital stays were compared using relative risks (RRs) and weighted mean differences (WMDs). RevMan 5.3 software was used for statistical analysis. Results Nine studies that included 3329 patients (1960 in the CO group) and 1369 in the NCO group comprised the analysis. The meta-analysis showed that CO was associated with a decreased 3-year OS rate (RR = 0.94, 95% CI 0.90–0.98, P = 0.005) and 5-year OS rate (RR = 0.93, 95% CI 0.88–0.98, P = 0.007). However, it was not associated with the 3-year RFS rate (RR = 0.97, 95% CI 0.90–1.04, P = 0.44), 5-year RFS (RR = 0.98, 95% CI 0.90–1.06, P = 0.60), or recurrence rate (RR = 1.17, 95% CI 0.95–1.45, P = 0.15) compared to the NCO group. For surgical-related outcomes, significant heterogeneity existed between the studies. Compared to the NCO group, CO was found to be associated with significantly more estimated blood loss (WMD = 250.90, 95% CI 105.90–396.28, P = 0.0007) and less harvested lymph nodes (WMD = − 3.59, 95% CI − 6.88, − 0.29, P = 0.03). Although, there was no significant difference in the surgical time (WMD = 15.93, 95% CI − 0.21, 32.07, P = 0.05). No statistically significant differences were observed in the rates of overall (P = 0.79) and major complications (P = 0.90), or the lengths of hospital stays (P = 0.11) between the two groups. Conclusions Based on the available evidence, CO is not superior to NCO in terms of survival. CO is not recommended as a routine surgery for gastric cancer. Future well-designed high-quality RCTs are warranted.

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Results of laparoscopic and open distal gastrectomies in patients with gastric cancer. Meta-analysis of Russian and European studies.

Problems in oncology ◽

10.37469/0507-3758-2021-67-2-181-189 ◽

2021 ◽

Vol 67 (2) ◽

pp. 181-189

Author(s):

Stanislav Panin ◽

Mihail Postolov ◽

Andrey Beburishvili ◽

Andrey Fedorov ◽

Alexandr Bykov ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Nodes ◽

Meta Analysis ◽

Surgical Techniques ◽

Postoperative Mortality ◽

Cochrane Library ◽

Sufficient Information ◽

European Studies ◽

High Level ◽

The Cochrane Library

Objective: to compare the results of laparoscopic and open distal gastrectomy in patients with gastric cancer according to Russian and European studies. Materials and methods: we searched the e-library, the Cochrane Library and PubMed. Literary references, tables of contents of specialized journals and protocols of research not yet completed have been studied. Statistical calculations (mean difference - MD, odds ratios - OR, 95 % confidence interval – 95 % CI) and meta-analysis graphs were performed using RevMan 5.4 software. Results: ten primary sources met the inclusion criteria (4 researches from the Russian Federation and 6 from other European countries). Laparoscopic and open gastric resections did not differ in the number of lymph nodes removed (MD = ‒1.31, 95 % CI from 3.51 to 0.89, p = 0.24). At the same time, laparoscopic operations are accompanied by less intraoperative blood loss (MD = –163, 95 % CI ‒268 to ‒57, p = 0.002), and open operations are shorter (MD = –38, 95 % CI –71 to ‒17, p = 0.004). The period of hospital stay is shorter after laparoscopic resections (MD = –4.1, 95 % CI –8.02 to –0.14, p = 0.04). Differences in mortality are not statistically significant (OR = 0.83, 95 % CI from 0.45 to 1.54, p = 0.55), but significantly lower after laparoscopic operations (2.3 %, 12/516) than after open (3.4 %, 92/2702), as well as the frequency of complications - 31.8 % (153/481) and 35.7 % (935/2658), respectively (OR = 1.05, 95 % CI from 0.84 to 1.37, p = 0.67). The overall five-year survival rate after laparoscopic operations varies from 48.1 % to 63.6 %, after laparotomy - from 43.4 % to 55.7 %. However, scattered and incomplete information on long-term outcomes did not allow a formal meta-analysis on comparative survival at this stage. The high level of performance of technically complex surgical techniques made it possible to significantly reduce the differences in duration between open and laparoscopic interventions (RS = ‒27, 95 % CI from 77 to 22, p = 0.28) and the duration of inpatient treatment after minimally invasive operations (RS = - 8.97, 95 % CI from ‒13.48 to ‒4.47, p <0.0001) in the subgroup of domestic studies. Conclusion: the direct results of laparoscopic subtotal distal gastric resections in Russian and European studies do not differ in terms of the amount of harvested lymph nodes, the number of complications and postoperative mortality. It is difficult to reliably assess the life expectancy of patients due to the lack of sufficient information at this stage, which requires the continuation of further research.

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Meta-analysis Comparison of Bilateral Axillo-Breast Approach Robotic Thyroidectomy and Conventional Thyroidectomy

Surgical Innovation ◽

10.1177/1553350618817145 ◽

2018 ◽

Vol 26 (1) ◽

pp. 112-123 ◽

Cited By ~ 5

Author(s):

Liqun Shan ◽

Jianing Liu

Keyword(s):

Lymph Nodes ◽

Surgical Outcomes ◽

Randomized Clinical Trials ◽

Weighted Mean Difference ◽

Meta Analysis ◽

Recurrent Laryngeal Nerve Palsy ◽

Operating Time ◽

Robotic Thyroidectomy ◽

Perioperative Outcomes ◽

Cochrane Library

Objective. Despite gaining popularity, bilateral axillo-breast approach robotic thyroidectomy (BABA RT) remains controversial. We performed a meta-analysis to evaluate the safety and effectiveness of BABA RT compared with open thyroidectomy (OT) in thyroid disease. Methods. A literature search was conducted using various databases, including PubMed, Web of Science, and Cochrane Library, up to February 2018. Outcomes of interest included patient characteristics, surgical outcomes, adverse events, complications, and surgical completeness. Results. A total of 11 publications including 2733 patients (1070 in the BABA RT and 1663 in the open group) were finally selected for the meta-analysis. BABA RT was associated with an equivalent complication rate, including transient and permanent hypocalcemia, transient and permanent recurrent laryngeal nerve palsy, bleeding, chyle leakage, and seroma, as well as surgical outcomes including tumor size, length of hospital stay, total drain amount, and pain score. BABA RT was also associated with an equivalent surgical completeness, including total dose of radioactive iodine, proportion of stimulated thyroglobulin (sTg) <1.0 ng/mL, and level of sTg. Moreover, BABA RT involved longer operative times (weighted mean difference [WMD] = 110.13; P < .00001), smaller number of retrieved lymph nodes(WMD = −1.26, P = .003), and more cost (WMD = 5811.18; P < .00001) compared with OT. Conclusions. BABA RT is safe and feasible and provides similar perioperative outcomes and complications when compared with OT. However, BABA RT was associated with longer operating time, fewer retrieved lymph nodes, and more cost. Randomized clinical trials with large samples and longer follow-up data are needed to more rigorously examine this effect.

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Can a subgroup at high risk for LRR be identified from T1-2 breast cancer with negative lymph nodes after mastectomy? A meta-analysis

Bioscience Reports ◽

10.1042/bsr20181853 ◽

2019 ◽

Vol 39 (9) ◽

Cited By ~ 1

Author(s):

Gongling Peng ◽

Zhuohui Zhou ◽

Ming Jiang ◽

Fan Yang

Keyword(s):

Breast Cancer ◽

High Risk ◽

Lymph Nodes ◽

Patient Population ◽

Meta Analysis ◽

Histologic Grade ◽

Surgical Margins ◽

Cochrane Library ◽

Increased Risk ◽

Negative Lymph Nodes

Abstract Purpose: To identify a subgroup at high risk for loco-regional recurrence (LRR) from T1-2 breast cancer with negative lymph nodes (N0) after mastectomy by using a meta-analysis. Methods and materials: Published studies on the relationship between clinical features and LRR of breast cancer were identified from public databases, including PubMed, EMBASE, and the Cochrane Library. High-risk features for LRR in this patient population were defined based on the pooled results of meta-analysis. Results: For the meta-analysis, a total of 11244 breast cancers with pT1-2N0 after mastectomy from 20 publications were included for analysis. The pooled results indicated that age (hazard ratio (HR) 1.77, P=0.001), lymphovascular invasion (LVI) (HR 2.23, P<0.001), histologic grade (HR 1.66, P<0.001), HER2 status (HR 1.65, P=0.027), menopausal status (HR 1.36, P=0.015), and surgical margins (HR 2.56, P=0.014) were associated with a significantly increased risk of developing LRR in this patient population group, but not for tumor size (HR 1.32, P=0.23), systematic therapy (HR 1.67, P=0.20), and hormonal receptor status (HR 1.04, P=0.73). Conclusion: In the current study, patients with young age, positive LVI, high histologic grade, HER-2 positive, premenopausal, and positive surgical margins have an increased risk of developing LRR. Further prospective trials are needed to clearly define the role of adjuvant postmastectomy radiotherapy in T1-2N0 breast cancer at high risk of developing LRR.

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Comparison of Retzius-Sparing Robot-Assisted Radical Prostatectomy vs. Conventional Robot-Assisted Radical Prostatectomy: An Up-to-Date Meta-Analysis

Frontiers in Surgery ◽

10.3389/fsurg.2021.738421 ◽

2021 ◽

Vol 8 ◽

Author(s):

Jiang-Nan Xu ◽

Zhen-Yu Xu ◽

Hu-Ming Yin

Keyword(s):

Radical Prostatectomy ◽

Lower Incidence ◽

Meta Analysis ◽

Cochrane Library ◽

Urinary Continence ◽

Robot Assisted ◽

Postoperative Continence ◽

Estimated Blood Loss ◽

Significant Difference ◽

Anterior Prostate

Background: The Retzius space-sparing robot-assisted radical prostatectomy (RS-RARP) has shown better results in urinary continence, but its efficacy and safety compared to conventional robot-assisted radical prostatectomy (c-RARP) remain controversial.Material and Methods: A research was conducted in Medline via PubMed, Cochrane Library, EMBASE, and Web of Science up to January 4, 2021, to identify studies comparing RS-RARP to c-RARP. We used RevMan 5.3 and STATA 14.0 for meta-analysis.Results: A total of 14 studies involving 3,129 participants were included. Meta-analysis showed no significant difference in positive surgical margins (PSMs), but the RS-RARP group had significantly higher PSM rates in the anterior site [odds ratio (OR) = 2.25, 95% CI: 1.22–4.16, P = 0.01]. Postoperative continence in RS-RARP group at 1 month (OR = 5.72, 95% CI: 3.56–9.19, P < 0.01), 3 months (OR = 6.44, 95% CI: 4.50–9.22, P < 0.01), 6 months (OR = 8.68, 95% CI: 4.01–18.82, P < 0.01), and 12 months (OR = 2.37, 95% CI: 1.20–4.70, P = 0.01) was significantly better than that in the c-RARP group. In addition, the RS-RARP group had a shorter console time (mean difference = −16.28, 95% CI: −27.04 to −5.53, P = 0.003) and a lower incidence of hernia (OR = 0.35, 95% CI: 0.19–0.67, P = 0.001). However, there were no significant differences in estimated blood loss, pelvic lymph node dissection rate, postoperative complications, 1-year-biochemical recurrence rate, and postoperative sexual function.Conclusions: Compared with c-RARP, RS-RARP showed better recovery of continence, shorter console time, and lower incidence of hernia. Although there was no significant difference in overall PSM, we suggest that the surgeon should be more careful if the lesion is in the anterior prostate.

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Reconstruction Methods and Complications of Esophagogastrostomy and Jejunal Interposition in Proximal Gastrectomy for Gastric Cancer: A Meta-Analysis

Gastroenterology Research and Practice ◽

10.1155/2020/8179254 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Nan Du ◽

Pei Wu ◽

Pengliang Wang ◽

Yuwei Du ◽

Kai Li ◽

...

Keyword(s):

Gastric Cancer ◽

Lower Risk ◽

Meta Analysis ◽

Proximal Gastrectomy ◽

Operating Time ◽

Perioperative Period ◽

Jejunal Interposition ◽

Cochrane Library ◽

Reconstruction Methods ◽

Significant Difference

Background. Proximal gastrectomy is used for the treatment of primary gastric cancer by open or laparoscopic surgery in the upper third of the stomach. Esophagogastrostomy (EG) or jejunal interposition (JI) is widely used in various reconstruction methods after proximal gastrectomy. We conducted a meta-analysis of EG and JI for treatment of gastric cancer. Materials and Methods. A search of PubMed, Embase, MEDLINE, J-STAGE, and Cochrane Library identified retrospective series on EG and JI. Weight mean differences (WMDs), odds ratios (ORs), and 95% confidence intervals (CIs) were used to analyze the operation-related data and postoperative complications. Heterogeneity was evaluated by the I2 test, and potential publication bias was assessed with Egger regression tests and sensitivity analysis. Results. Eight studies were selected, and 496 patients were included. EG group benefits were 44.81 min shorter operating time (P<0.001), 56.58 mL less blood loss (P=0.03), and 7.4 days shorter hospital stay time (P<0.001) than the JI group. Between the two groups, there was no significant difference in anastomotic leakage; otherwise, the EG group had a lower risk of anastomotic stenosis (OR=0.44, 95%CI=0.20 to 0.97, P=0.04), lower risk of intestinal obstruction (OR=0.07, 95%CI=0.01 to 0.43, P=0.004), and higher risk of reflux esophagitis (OR=2.47, 95%CI=1.07 to 5.72, P=0.03). Conclusion. The results of our study indicated that EG has significant advantages during the perioperative period and in short-term outcomes compared to JI.

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Improved Overall Survival of Colorectal Cancer under Multidisciplinary Team: A Meta-Analysis

BioMed Research International ◽

10.1155/2021/5541613 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Dong Peng ◽

Yu-Xi Cheng ◽

Yong Cheng

Keyword(s):

Colorectal Cancer ◽

Overall Survival ◽

Multidisciplinary Team ◽

Meta Analysis ◽

Postoperative Mortality ◽

Stage Iv ◽

Cochrane Library ◽

Stage Iv Colorectal Cancer ◽

Significant Difference ◽

Colorectal Cancer Patients

Purpose. The purpose of the current meta-analysis was to evaluate whether multidisciplinary team improved overall survival of colorectal cancer. Methods. PubMed, EMBASE, and Cochrane Library database were searched from inception to October 25, 2020. The hazard ratio (HR) and 95% confidence (CI) of overall survival (OS) were calculated. Results. A total of 11 studies with 30814 patients were included in this meta-analysis. After pooling the HRs, the MDT group was associated with better OS compared with the non-MDT group ( HR = 0.81 , 95% CI 0.69-0.94, p = 0.005 ). In subgroup analysis of stage IV colorectal cancer, the MDT group was associated with better OS as well ( HR = 0.73 , 95% CI 0.59-0.90, p = 0.004 ). However, in terms of postoperative mortality, no significant difference was found between MDT and non-MDT groups ( OR = 0.84 , 95% CI 0.44-1.61, p = 0.60 ). Conclusion. MDT could improve OS of colorectal cancer patients.

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The Survival Benefit and Safety of Splenectomy for Gastric Cancer With Total Gastrectomy: Updated Results†

Frontiers in Oncology ◽

10.3389/fonc.2020.568872 ◽

2021 ◽

Vol 10 ◽

Author(s):

Kun Yang ◽

Zhi-Yun Zang ◽

Kai-Fan Niu ◽

Li-Fei Sun ◽

Wei-Han Zhang ◽

...

Keyword(s):

Gastric Cancer ◽

Overall Survival ◽

Survival Rate ◽

Lymph Nodes ◽

Meta Analysis ◽

Postoperative Mortality ◽

Sensitivity Analyses ◽

Cochrane Central Register ◽

Overall Survival Rate ◽

Duration Of Surgery

BackgroundSplenectomy was traditionally performed to dissect the splenic hilar lymph nodes. Considering the important functions of spleen, whether splenectomy would bring beneficial to gastric cancer patients is debatable. This meta-analysis aimed to make an updated evaluation on the effectiveness and safety of splenectomy.MethodsLiterature searches were performed to identify eligible RCTs concerning effectiveness or safety of splenectomy with gastrectomy from PubMed, MEDLINE, CBMdisc, EMBASE, and Cochrane Central Register of Controlled Trials. Two reviewers completed the study selection, data extraction, and quality assessment independently. The meta-analyses were performed by RevMan 5.3.ResultsA total of 971 patients from four studies were included (485 in splenectomy group and 486 in spleen preservation group). Splenectomy did not increase 5-year overall survival rate (RR=1.05, 95% CI: 0.96, 1.16) or increase postoperative mortality (RR=1.21, 95% CI: 0.41, 3.54). However, the analysis demonstrated that gastrectomy with splenectomy had significantly higher incidence of postoperative complications (RR=1.80, 95% CI: 1.33, 2.45). No significant differences were found in terms of the number of resected lymph nodes and reoperation rate; however, splenectomy had a tendency to prolong the duration of surgery and hospital stays. Subgroup analyses indicated that splenectomy could not increase overall survival rate for either whole or proximal gastric cancer. Sensitivity analyses also found similar results compared to the primary analyses.ConclusionsSplenectomy cannot benefit the survival of patients with tumor located at lesser curvature, and it could instead increase postoperative morbidity.

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Effect of preoperative biliary drainage in patients with moderately severe obstructive jaundice on the outcomes of pancreatoduodenectomy: A meta-analysis study

10.21203/rs.2.18871/v1 ◽

2019 ◽

Author(s):

Xiaolei Wang ◽

Shanshan Meng ◽

Yaowei Hu ◽

Kehang Duan ◽

Feng Wei

Keyword(s):

Blood Loss ◽

Total Bilirubin ◽

Meta Analysis ◽

Operating Time ◽

Preoperative Biliary Drainage ◽

Postoperative Hospital Stay ◽

Mean Difference ◽

Perioperative Outcomes ◽

Perioperative Mortality ◽

Estimated Blood Loss

Abstract Background The purpose of this meta-analysis was to examine the impact of preoperative biliary drainage (PBD) on the perioperative outcomes of pancreatoduodenectomy (PD) in patients with total bilirubin >100 umol/L.Methods In this meta-analysis, studies that compared the perioperative outcomes of PBD and non-PBD patients with total bilirubin >100 umol/L, and were published in EMBASE, PubMed, the Cochrane library, Web of Science, VIP database, Wanfang data, Chinese biomedical literature and CNKI database from inception up to October 2019 were included. The odds ratios (OR) or mean differences were calculated with 95% confidence intervals (CI).Results Nine trials with 744 patients, which compared PBD (267 patients) with non-PBD (477 patients), were included. There was no significant difference in perioperative mortality between these two groups (OR: 0.51, 95% CI: 0.19 to 1.39; P =0.19). Postoperative hospital stay (mean difference: -2.35, 95% CI: -3.70 to -1.00; P =0.0007), operating time (mean difference: -33.03, 95% CI: -44.14 to 21.93; P <0.00001), estimated blood loss (mean difference: -141.18, 95% CI: -213.25 to -69.11; P =0.0001) and overall morbidity (OR: 0.68, CI: 0.48 to 0.95; P =0.02) were significantly lower in the PBD group than in the non-PBD group.Conclusion Patients who received PBD had similar perioperative mortality, but had decreased postoperative hospital stay, operating time, estimated blood loss and overall morbidity, when compared to patients without PBD. Therefore, PBD should be routinely performed for patients planned for PD with a total bilirubin of >100 umol/L.

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