Defining the Safety Profile for Performing Pancreatoduodenectomy in the Setting of Hyperbilirubinemia

Chen, Bofeng; Trudeau, Maxwell T.; Maggino, Laura; Ecker, Brett L.; Keele, Luke; DeMatteo, Ronald P.; Drebin, Jeffrey A.; Fraker, Douglas L.; Lee, Major K.; Roses, Robert E.; Vollmer, Charles M.

doi:10.1245/s10434-019-08044-w

Cited by 6 publications

(1 citation statement)

References 31 publications

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“…In recent years, high TBIL has been thought to increase the risk of postoperative complications, and preoperative biliary drainage can improve postoperative outcomes [13,14]. However, regarding TBIL, the relationship between preoperative biliary decompression, perioperative complication rate, and mortality has been a hot topic of controversy [15][16][17].…”

Section: Discussionmentioning

confidence: 99%

Total bilirubin level on postoperative day 3 in predicting clinically relevant pancreatic fistula after pancreaticoduodenectomy : a retrospective study

Wang,

Qin,

Zhang

et al. 2024

Preprint

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Background: The prevalence of clinically relevant postoperative pancreatic fistulas (CR-POPF) following pancreaticoduodenectomy (PD) is relatively high. Most studies on the prediction of CR-POPF are limited to pre-operation, while there are few indicators to predict CR-POPF in the early postoperative period. The purpose of this study was to investigate the value of total bilirubin (TBIL) level on postoperative day 3 in predicting CR-POPF after PD. Methods: The clinical data of 170 patients who underwent PD in our team from January 2015 to October 2022 was retrospectively analyzed into two groups: the CR-POPF group with a grade B or C pancreatic fistula (n = 37), the no CR-POPF group with a non-pancreatic fistula, and the biochemical fistula patients (n = 133). Univariate and multivariate analyses were used to screen the potential indicators for predicting CR-POPF. The predictive value of risk factors was assessed by area under the ROC curve. Results: Preoperative variables, including hemoglobin (Hb), C-reactive protein (CRP), TBIL, albumin (ALB), pancreatic texture, hemorrhage, duct diameter, and TBIL on postoperative day 3, were identified as predictors of clinically relevant postoperative pancreatic fistula (CR-POPF) after pancreaticoduodenectomy (PD) (p < 0.001). The multivariate logistic regression analysis revealed that pancreatic texture (p = 0.004), postoperative TBIL (p<0.001), and preoperative CRP (p = 0.048) were identified as independent risk variables. To predict CR-POPF, the area under the curve (AUC) of pancreatic texture, TBIL on the third day of surgery, and preoperative CRP were found to be 0.607, 0.824, and 0.726, respectively. Conclusion: The TBIL level on postoperative day 3 is a significant predictor of CR-POPF after PD which can accurately predict CR-POPF.

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