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.