Effect of Preoperative Biliary Drainage on Peripheral Circulating Tumor Cells after Pancreaticoduodenectomy in Patients with Resectable Periampullary Carcinoma and Obstructive Jaundice

Background: Circulating tumor cells (CTCs) are pivotal in determining postoperative prognosis in periampullary carcinoma. However, the influence of preoperative biliary drainage (PBD) on CTC levels after pancreaticoduodenectomy (PD) remains unclear. Therefore, we explored the correlation of PBD with post-PD CTC changes in patients with resectable periampullary carcinoma and obstructive jaundice. Methods: We conducted a retrospective analysis of 125 patients with periampullary malignancies who underwent PD at Beijing Friendship Hospital, Capital Medical University, between June 2017 and October 2024. Participants were stratified into PBD and non-PBD (control) groups. Propensity score matching (PSM) was employed to balance baseline characteristics, followed by binary multivariate logistic regression. Multiple linear regression was further utilized to identify factors influencing postoperative CTC levels. Results: Serial CTC analysis demonstrated a significantly higher rate of postoperative CTC reduction in the PBD group compared to the control group (64.3% vs. 27.3%, P<0.001), along with a greater proportion of patients converting from CTC-positive to CTC-negative status (35.7% vs. 0%, P<0.001). Subgroup analysis revealed that antegrade drainage was superior to retrograde drainage in reducing postoperative bilirubin levels (P<0.05). Binary logistic regression confirmed PBD as an independent protective factor against postoperative CTC increase (P<0.01). Conclusions: PBD was significantly associated with postoperative positive-to-negative CTC conversion and lower postoperative CTC levels. These findings support the role of PBD as an independent protective factor against CTC elevation following surgery.