Association of the rate of bilirubin decrease with major morbidity in patients undergoing preoperative biliary drainage before pancreaticoduodenectomy

Abstract

Objective: The objective of this study was to examine the relationship between the rate of bilirubin decrease following preoperative biliary drainage before pancreaticoduodenectomy and postoperative morbidity. Methods: Records of patients who underwent pancreaticoduodenectomy at the Department of Surgery in Ramathibodi Hospital between January 2008 and December 2019 were retrospectively reviewed. The patients were classified into either an adequate or inadequate drainage rate groups according to the bilirubin decrease rate. Major morbidity was defined as higher than grade II in the Clavien-Dindo classification. Risk factors for major morbidity were analyzed by logistic regression analysis. Results: In total, 166 patients were included in the study. Major morbidity was observed in 36 patients (21.6%). Adequate biliary drainage rate was observed in 39 patients (23.4%). Patients who had major morbidity were less likely to have come from the adequate biliary drainage rate group than the inadequate group (38.9% vs. 61.1%). However, through multivariate logistic analysis, only body mass index, operative time, and pancreatic duct diameter were independent factors associated with major morbidity, whereas the bilirubin decrease rate was not. Conclusions: Bilirubin decrease rate following preoperative biliary drainage has no significant association with major postoperative morbidity after pancreaticoduodenectomy.

Postoperative outcomes of resectable periampullary cancer accompanied by obstructive jaundice with and without preoperative endoscopic biliary drainage

“…Nonetheless, these 3 variables were not significantly associated with 1-year mortality. Of note, serum bilirubin level at the diagnosis in our study (mean 14.3 ± 7.8 mg/dL) was higher than that reported in other studies ( 1 , 18 ), which may represent the late presentation or the longer time to diagnosis of patients in this study. Moreover, the waiting time for surgery in the present study (median 30 days; IQR 15-53.5 days) was quite longer than that reported in previous studies (1-2 weeks) even none of the patients received neoadjuvant chemotherapy ( 1 , 19 ), which reflects the situation in developing countries where the healthcare system is usually overwhelmed.…”

“…The mean preoperative bilirubin level sharply declined from 12.7 to 1.8 mg/dL within 2 weeks after endoscopic biliary drainage in the PBD group, indicates the adequacy of biliary decompression, according to the European Society of Gastrointestinal Endoscopy (ESGE) guidelines ( 20 ). Adequate PBD in patients with periampullary cancer has been reported benefit in reducing the occurrence of major morbidities (38.9% vs 61.1%) postoperatively compared to inadequate drainage ( 18 ). This might support our results PBD advantages in terms of the lower rates of intraoperative bleeding and bile leakage compared with the DS group.…”

Risk prediction program for choosing methods of biliary tract decompression in patients with obstructive jaundice caused by tumors: clinical testing

“…Наиболее частой локализацией опухоли, приводящей к развитию МЖ, является головка поджелудочной железы. Заболеваемость раком поджелудочной железы (ПЖ) неуклонно возрастает и составляет 9-10/100 000 населения в год, смертность от рака ПЖ в течение первого года составляет 98 % и не имеет отчетливой тенденции к снижению [8,9]. Тяжелым и нередко фатальным осложнением механической желтухи является печеночная недостаточность, переходящая в случае неустранения обструкции билиарного тракта и непринятия иных мер патогенетического лечения в печеночно-почечную и затем в полиорганную недостаточность (ПОН).…”