The Impact Of The Reoperative Bilirubin Level On Pancreaticoduodenectomy

Objective:To understand the impact of the preoperative bilirubin level on pancreaticoduodenectomy(PD)and to find the related risk factor of postoperative complications.Meanwhile,discuss whether preoperative biliary drainage(PBD)is necessary for patients with resectable pancreatic cancer who had obstructive jaundice.Methods:Totally 74 clinical cases from January 2010 to October 2016 who had preoperative jaundice and had undergoing PD were retrospectively analyzed in the Sir Run Run Shaw Hospital of Zhejiang University School of Medicine.There was a total of 48 men and 26 women,the ratio of male to female is 1.846:1.The age range is 43-80(average 62.97±8.67).The preoperative TBIL level range is 36.7-719.3μmol/L(average 244.40±162.76μmol/L).All 74 patients were pancreatic head carcinoma and had undergoing PD(22 laparoscope,52 laparotomy).There were 6 patients had taken PBD(all had undergoing PTCD)and 68 patients without taking PBD).According to the level of preoperative TBIL,patients were divided into three groups:mild jaundice group(<171 μmol/L),moderate jaundice group(171-342μmol/L)and severe jaundice group(>342μmol/L).Comparison was made of general date,perioperative indicators,postoperative complications,mortality and prognosis in three groups to understand the impact of the preoperative TBIL level on PD.Analyze the related risk factor of postoperative complications.Meanwhile,compare the difference of PBD group and no PBD group.The data was analyzed with SPSS 22.0 software.A P value of<0.05 was considered statistically significant.Results:The blood loss during operation was statistically significant in three group(P=0.008),moderate jaundice group had high blood loss than other two groups.There was no significant difference(P>0.05)on gender,age,BMI,operation time,TNM-staging,length of stay(LOS),postoperative LOS,hospitalizationcosts in three groups.There was no significant difference(P>0.05)on postoperative complications and mortality.Logistic analysis showed that age≥65(OR=16.002,95%CI:1.682-152.264,P=0.016),male(OR=10.036,95%CI:1.920-52.464,P=0.006)were two independent risk factors of postoperative complications.There was no significant difference(P>0.05)between postoperative complications and preoperative TBIL level,preoperative DBIL level.The median survival time of mild jaundice group is 8.9m,the median survival time of moderate jaundice group is 12.9m,the median survival time of severe jaundice group is 12.1m.There was no significant difference(P=0.678)of prognosis between three group.There was no significant difference(P>0.05)on BMI,operation time,blood loss during operation,LOS,postoperative LOS,hospitalization costs,postoperative complications and mortality between PBD group and no PBD group.Conclusion:Preoperative TBIL level had little impact on PD.PBD had limited value,it should depend on general conditions of patients,treatment and whetherwith jaundice associated symptoms.