Effect of Pre-operative Biliary Drainage on Surgical Outcomes after Pancreaticoduodenectomy in Patients with Common Bile Duct Cancer.
- Author:
Jae Myeong LEE
1
;
Young Joo LEE
;
Chan Wook KIM
;
Ki Miung MOON
;
Myung Wook KIM
Author Information
1. Department of surgery, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea. yjlee@amc.seoul.kr
- Publication Type:Original Article
- Keywords:
drainage;
bilirubin;
common bile duct neoplasm;
pancreaticoduodenectomy
- MeSH:
Bile Ducts, Extrahepatic;
Bilirubin;
Cholangitis;
Common Bile Duct;
Creatinine;
Drainage;
Female;
Hemoglobins;
Humans;
Jaundice, Obstructive;
Korea;
Male;
Pancreaticoduodenectomy
- From:Korean Journal of Hepato-Biliary-Pancreatic Surgery
2009;13(2):103-108
- CountryRepublic of Korea
- Language:English
-
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.
