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Background <p>Optimal management of patients with severe hyperbilirubinemia (&gt; 14.6 mg/dL) undergoing pancreaticoduodenectomy remains controversial.</p> Methods <p>Single-center retrospective study of 665 pancreaticoduodenectomies (2007–2024). Patients were stratified: no preoperative biliary drainage (PBD) with high (&gt; 14.6mg/dL, <i>n</i> = 83) or low (&lt; 14.6mg/dL, <i>n</i> = 312) bilirubin; PBD for low bilirubin (<i>n</i> = 140); PBD for high bilirubin (<i>n</i> = 113). Primary outcomes: 90-day mortality, morbidity, and specific complications.</p> Results <p>Ninety-day mortality was significantly higher in non-PBD patients with high bilirubin (13.3%) compared to other groups (2.9–5.7%, <i>p</i> = 0.001). Overall morbidity was also higher in this group (29.0% vs. 12.8–20.7%, <i>p</i> &lt; 0.001). While PBD groups showed higher surgical site infections (21.2–26.4% vs. 9.6%, <i>p</i> = 0.001), non-PBD high-bilirubin patients demonstrated increased ARDS (6.0% vs. 0–1.4%, <i>p</i> = 0.016) and reoperation rates (18.1% vs. 9.3–11.5%, <i>p</i> = 0.029). Multivariate analysis identified preoperative bilirubi<i>n</i> &gt; 14.6mg/dL as an independent predictor of 90-day mortality.</p> Conclusion <p>Preoperative bilirubin ≥ 14.6mg/dL independently predicts perioperative morbidity and mortality following pancreaticoduodenectomy. These findings support preoperative biliary drainage in patients with severe hyperbilirubinemia to optimize surgical outcomes, despite PBD-associated infectious complications.</p>

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Impact of preoperative biliary drainage on outcomes of pancreaticoduodenectomy in severe hyperbilirubinemia

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年8月13日

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  • Fahim Kanani,
  • Nir Messer,
  • Bar Cohen,
  • Ella Falk,
  • Yaacov Goykhman,
  • Nir lubezky

摘要

Background

Optimal management of patients with severe hyperbilirubinemia (> 14.6 mg/dL) undergoing pancreaticoduodenectomy remains controversial.

Methods

Single-center retrospective study of 665 pancreaticoduodenectomies (2007–2024). Patients were stratified: no preoperative biliary drainage (PBD) with high (> 14.6mg/dL, n = 83) or low (< 14.6mg/dL, n = 312) bilirubin; PBD for low bilirubin (n = 140); PBD for high bilirubin (n = 113). Primary outcomes: 90-day mortality, morbidity, and specific complications.

Results

Ninety-day mortality was significantly higher in non-PBD patients with high bilirubin (13.3%) compared to other groups (2.9–5.7%, p = 0.001). Overall morbidity was also higher in this group (29.0% vs. 12.8–20.7%, p < 0.001). While PBD groups showed higher surgical site infections (21.2–26.4% vs. 9.6%, p = 0.001), non-PBD high-bilirubin patients demonstrated increased ARDS (6.0% vs. 0–1.4%, p = 0.016) and reoperation rates (18.1% vs. 9.3–11.5%, p = 0.029). Multivariate analysis identified preoperative bilirubin > 14.6mg/dL as an independent predictor of 90-day mortality.

Conclusion

Preoperative bilirubin ≥ 14.6mg/dL independently predicts perioperative morbidity and mortality following pancreaticoduodenectomy. These findings support preoperative biliary drainage in patients with severe hyperbilirubinemia to optimize surgical outcomes, despite PBD-associated infectious complications.