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

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 or = 5.0 mg/dl (N = 86). In the bilirubin or = 5.0 group (p = 0.032). CONCLUSION: The pre-operative bilirubin 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.