Preoperative biliary drainage in severely jaundiced patients with pancreatic head cancer: A retrospective cohort study

Impact of serum bilirubin levels and preoperative biliary drainage on perioperative complications of pancreaticoduodenectomy

Background

The effect of elevated preoperative serum bilirubin on complications after pancreaticoduodenectomy (PD) remains uncertain. Preoperative biliary drainage (PBD) effectively reduces serum bilirubin values; however, its impact on PD complications remains debatable.

Methods

We conducted a retrospective analysis on patients who underwent PD at the First Affiliated Hospital of Chongqing Medical University from October 2018 to July 2023. Patients were categorized into quartiles based on preoperative serum bilirubin levels. Multivariable logistic regression was used to investigate the relationship between bilirubin and the risk of PD complications. Restricted cubic spline (RCS) analysis was conducted to assess the dose-response relationship between bilirubin levels and PD complications. Furthermore, a 3-way interaction of PD complications, preoperative serum bilirubin, and PBD was examined.

Results

A total of 326 patients participated in the study. Multivariate logistic regression analysis revealed that higher preoperative serum bilirubin levels increased the likelihood of perioperative PD complications. RCS analysis revealed a significant linear dose-response relationship between bilirubin levels and the risk of PD complications. While PBD did not independently affect PD complications, there was a significant 3-way interaction of PD complications, preoperative serum bilirubin levels, and PBD, indicating that patients with serum bilirubin values exceeding 10 times the upper limit of normal (≥ 171 μmol/L) exhibited a lower risk of complications through PBD.

Conclusion

Elevated preoperative serum bilirubin increases the risk of complications after PD. Patients with high preoperative serum bilirubin values (≥ 171 μmol/L) undergoing PD benefit from PBD.

Value of preoperative biliary drainage in pancreatic head cancer patients with severe obstructive jaundice: A multicenter retrospective study

BACKGROUND

Pancreatic head cancer accompanied by obstructive jaundice is a common clinical situation. The aim of this study was to assess the impact of preoperative biliary drainage (PBD) on clinical outcomes in patients with severe obstructive jaundice.

METHODS

Patients with a bilirubin level of ≥250 μmol/L at diagnosis who underwent PBD were included. The primary endpoints and secondary endpoints were the postoperative severe complications rates. Secondary endpoints were the degree of improvement in general condition, predictors of severe postoperative complications, and the impact of PBD on patients with bilirubin levels >300 μmol/L.

RESULTS

In total, 289 patients were included, and 188 patients (65.1%) underwent PBD. The patients who met the American Society of Anesthesiologists (ASA) classification II-III stages decreased from 119 to 100 ( P = 0.047) after PBD. The overall severe complications were significantly more frequent in the direct surgery (DS) group than in the PBD group (34.7% vs. 22.9%, P = 0.031), especially the postoperative hemorrhage (6/43 [14.0%] vs. 9/35 [25.7%], P = 0.038) and intra-abdominal infection (6/43 [14.0%] vs. 10/35 [28.6%], P = 0.018). The ASA classifications II-III (odds ratio [OR]=2.89, 95% confidence interval [CI]: 1.38-4.31), P = 0.01) and DS (OR = 3.65, 95% CI: 1.45-7.08; P = 0.003) were independently associated with severe postoperative complications. The occurrence rate of severe postoperative complications in patients with a bilirubin level >300 μmol/L who underwent PBD was significantly lower than in patients who underwent DS (25.6% vs. 40.6%, P = 0.028), but the benefit of PBD was not observed in patients who had a bilirubin level between 250 and 300 μmol/L.

CONCLUSION

PBD is useful in reducing severe postoperative complications, especially in patients with bilirubin levels >300 μmol/L.