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.
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.
Choi
Yun Mee
YM
Department of Surgery, College of Medicine, Inha University, 7-206, 3-Ga Sinheung Dong, Jung-Gu, Incheon 400-711, Korea.
Cho
Eung-Ho
EH
Lee
Keon-Young
KY
Ahn
Seung-Ik
SI
Choi
Sun Keun
SK
Kim
Sei Joong
SJ
Hur
Yoon Seok
YS
Cho
Young Up
YU
Hong
Kee Chun
KC
Shin
Seok Hwan
SH
Kim
Kyung Rae
KR
Woo
Ze-Hong
ZH
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
D001663:Bilirubin