title: Effect of preoperative biliary drainage on surgical results after pancreaticoduodenectomy in patients with distal common bile duct cancer: focused on the rate of decrease in serum bilirubin.
abstract: OBJECTIVE
  To examine if the rate of decrease in serum bilirubin after preoperative biliary drainagecan be used as a predicting factor for surgical complications and postoperative recovery after pancreaticoduodenectomy in patients with distal common bile duct cancer.
  
  
  METHODS
  A retrospective study was performed in 49 consecutive patients who underwent pancreaticoduodenectomy for distal common bile duct cancer. Potential risk factors were compared between the complicated and uncomplicated groups. Also, the rates of decrease in serum bilirubin were compared pre- and postoperatively.
  
  
  RESULTS
  Preoperative biliary drainage (PBD) was performed in 40 patients (81.6%). Postoperative morbidity and mortality rates were 46.9% (23/49) and 6.1% (3/49), respectively. The presence or absence of PBD was not different between the complicated and uncomplicated groups. In patients with PBD, neither the absolute level nor the rate of decrease in serum bilirubin was significantly different. Patients with rapid decrease preoperatively showed faster decrease during the first postoperative week (5.5 +/- 4.4 micromol/L vs -1.7 +/- 9.9 micromol/L, P = 0.004).
  
  
  CONCLUSIONS
  PBD does not affect the surgical outcome of pancreaticoduodenectomy in patients with distal common bile duct cancer. There is a certain group of patients with a compromised hepatic excretory function, which is represented by the slow rate of decrease in serum bilirubin after PBD.
authors.affiliation: Department of Surgery, College of Medicine, Inha University, 7-206, 3-Ga Sinheung Dong, Jung-Gu, Incheon 400-711, Korea.
authors.forename: Yun Mee
authors.initials: YM
authors.lastname: Choi
authors.forename: Eung-Ho
authors.initials: EH
authors.lastname: Cho
authors.forename: Keon-Young
authors.initials: KY
authors.lastname: Lee
authors.forename: Seung-Ik
authors.initials: SI
authors.lastname: Ahn
authors.forename: Sun Keun
authors.initials: SK
authors.lastname: Choi
authors.forename: Sei Joong
authors.initials: SJ
authors.lastname: Kim
authors.forename: Yoon Seok
authors.initials: YS
authors.lastname: Hur
authors.forename: Young Up
authors.initials: YU
authors.lastname: Cho
authors.forename: Kee Chun
authors.initials: KC
authors.lastname: Hong
authors.forename: Seok Hwan
authors.initials: SH
authors.lastname: Shin
authors.forename: Kyung Rae
authors.initials: KR
authors.lastname: Kim
authors.forename: Ze-Hong
authors.initials: ZH
authors.lastname: Woo
mesh_terms: D000368:Aged; D001663:Bilirubin / Q000097:blood*; D003138:Common Bile Duct Neoplasms / Q000097:blood / Q000601:surgery* / Q000628:therapy; D004322:Drainage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000009:adverse effects; D011183:Postoperative Complications / Q000209:etiology; D011300:Preoperative Care; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D001663:Bilirubin