Introduction : The PBD in ampulla of Vater (AoV) cancer is often indiscriminately performed without logical backgrounds, and recent studies reported its adverse effects. Larger scale study is needed to clarify the effect of PBD on AoV cancer. This study was performed to evaluate the effect of preoperative biliary drainage (PBD) on postoperative and long-term oncological outcomes in patients with AoV cancers.

Methods : Data of 313 patients who underwent pancreaticoduodenectomy and was pathologically diagnosed as AoV cancer between January 2000 and December 2014 were collected and reviewed.

Results : Among the 313 patients, 167 patients (53.4%) underwent PBD: Endoscopic biliary drainage was performed in 106 patients (33.9%) and percutaneous transhepatic biliary drainage in 61 (19.5%). The PBD group had significantly higher postoperative complication rate than the upfront surgery group (48.5% vs. 38.4%, p=0.045). The 5-year disease-free survival rate (5Y-DFSR) was significantly lower in the PBD group compared to the upfront surgery group (53.8% vs. 74.3%, p<0.001). Worse 5Y-DFSR of PBD group was more evident in patients with T1 or T2 diseases (59.2% vs. 84.1%, p<0.001). In multivariate analysis with T1/T2 disease patients PBD was independently associated with worse disease-free survival (hazard ratio, 2.145 [95% confidence interval, 1.202–3.826], p=0.010).

Conclusions : For T1 or T2 AoV cancer, PBD adversely affected the short-term perioperative complication rate as well as the long-term oncologic outcomes. Therefore, routine practice of PBD should be refrained and be reserved for selected cases such as cholangitis, especially in patients with T1/T2 AoV cancer.