Effect of Pre-operative Biliary Drainage on Surgical Outcomes after Pancreaticoduodenectomy in Patients with Common Bile Duct Cancer

Lee, Jae Myeong; Lee, Young Joo; Kim, Chan Wook; Moon, Ki Miung; Kim, Myung Wook

Abstract

INTRODUCTION: Biliary drainage is tried before surgery because it is thought that obstructive jaundice is associated with post-operative mortality and morbidity. However, there are no confirmed criteria about the optimal operation time after drainage. We attempted to determine the appropriate pre-operative bilirubin level after drainage which should be achieved before pancreaticoduodenectomy is done for extrahepatic bile duct cancer.
METHODS
We reviewed 100 patients (69 males and 31 females with a mean age of 61.3 +/- 9.4 years) who underwent pancreaticoduodenectomy after a pre-operative biliary drainage procedure for distal common bile duct cancer by one surgeon at the Asan Medical Center in Seoul Korea between 1994 and 2005.
RESULTS
We compared the group with pre-operative bilirubin levels < 5.0 mg/dl (N = 14) with the group with a bilirubin levels > or = 5.0 mg/dl (N = 86). In the bilirubin <5.0 group, the preoperative hemoglobin level was lower (p = 0.001), the pre-operative creatinine level was higher (p = 0.000), pre-operative cholangitis was more frequent (p = 0.034), and the bilirubin level at the time of admission was also higher (p = 0.000). The bilirubin < 5.0 group showed no postoperative morbidity, while there was a 25.6% morbidity rate in the bilirubin > or = 5.0 group (p = 0.032).
CONCLUSION
The pre-operative bilirubin < 5.0 and > or = 5.0 groups had a clear difference in postoperative morbidity. Therefore, we suggest waiting until the pre-operative bilirubin level decreases to <5.0 mg/dl after biliary drainage.