Evaluation of surgical risk in preoperative biliary drainage patients by blood chemistry laboratory data--with special reference to rate of reduction of serum bilirubin levels.
OBJECTIVE
In Japan, it is generally accepted that biliary decompression should be performed before surgical operations on patients with obstructive jaundice. However, even when adequate decompression and effective reduction of serum bilirubin levels are achieved before surgical operations, it is not uncommon for unforeseen postoperative complications to occur. In this study, we analyzed the effectiveness of biliary drainage prior to pancreatoduodenectomy in patients with malignant obstruction of the papilla of Vater clinically manifested by obstructive jaundice.


METHODS
We retrospectively examined the serial blood chemistry laboratory data of 44 patients with periampullary carcinoma who had preoperative obstructive jaundice and underwent pancreatoduodenectomy during the last 10 years. We divided the cases into three groups according to the rate of decrease in serum bilirubin levels, "b": group I, b <-0.09; group II, -0.09<b<-0.05; and group III, -0.05<b. There were no significant differences between the three groups in regard to sex, location of tumor and method of biliary decompression, however, there was significantly higher morbidity rate in group III.


RESULTS
The level of biliary enzymes (gamma-GTP, ALP) tended to be higher in group I and lower in group III. Although TB and DB decreased to below 5 mg/dl before pancreatoduodenectomy in all three groups, transaminase levels instead rose in group III just before pancreatoduodenectomy.


CONCLUSIONS
This suggested that liver damage continued to progress after biliary decompression when the reduction rate was low, and thus we should carefully monitor such patients for postoperative complications.
Nakayama
T
T
Second Department of Surgery, Kurume University, Japan.
Tamae
T
T
Kinoshita
H
H
Okuda
K
K
Imayama
Y
Y
Saitoh
N
N
Shibata
J
J
Aoki
E
E
Hasuda
A
A
Saitsu
H
H
D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D001661:Biliary Tract Neoplasms / Q000097:blood* / Q000150:complications / Q000601:surgery*; D001663:Bilirubin / Q000097:blood*; D002779:Cholestasis / Q000097:blood* / Q000209:etiology / Q000601:surgery*; D004322:Drainage; D005260:Female; D006801:Humans; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome
D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D001663:Bilirubin