Predictive Power of Preoperative Serum Total Bilirubin for the Outcomes Following Pancreaticoduodenectomy

Background: The high levels of bilirubin in patients with periampullary cancers may increase the morbidity or mortality after curative surgery. Objectives: We aimed at evaluating the predictive power of preoperative serum total bilirubin for the outcomes after pancreaticoduodenectomy (PD) in resectable periampullary cancers. Methods: The data of 80 patients, who had undergone PD, were retrospectively analyzed. Regarding the preoperative bilirubin, we opted for 20 mg/dL as the cut-off value to divide patients into two groups to be subjected to simple and multiple logistic regression. Results: A total of 80 patients with a mean age of 54.90 ± 14.33 years underwent PD. The median preoperative bilirubin level was 4.7 mg/dL and the majority of cases (88.8%) had bilirubin < 20 mg/dL. While there was no significant difference in the mortality between bilirubin groups (P = 0.266), bilirubin≥20 mg/dL remarkably increased the postoperative morbidity (P = 0.012, Odds ratio = 3.04); 57.5% of cases underwent biliary drainage before surgery, which did not impact the mortality and morbidity. Multiple analysis by a logistic regression model disclosed that the only statistically significant variable for mortality was the total operative time (P = 0.038) and among all factors, total bilirubin level was the only independent predictor for the morbidity status (P = 0.009). Conclusions: This study suggested that preoperative biliary drainage should only be limited to patients with high bilirubin levels (≥ 20 mg/dL) or expected delayed surgeries.