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Defining the Safety Profile for Performing Pancreatoduodenectomy in the Setting of Hyperbilirubinemia

  • Pancreatic Tumors
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Abstract

Background

Hyperbilirubinemia is commonly observed in patients requiring pancreatoduodenectomy (PD). Thus far, literature regarding the danger of operating in the setting of hyperbilirubinemia is equivocal. What remains undefined is at what specific level of bilirubin there is an adverse safety profile for undergoing PD. The aim of this study is to identify the optimal safety profile of patients with hyperbilirubinemia undergoing PD.

Patients and Methods

The present work analyzed 803 PDs from 2004 to 2018. A generalized additive model was used to determine cutoff values of total serum bilirubin (TB) that were associated with increases in adverse outcomes, including 90-day mortality. Subgroup comparisons and biliary stent-specific analyses were performed for patients with TB below and above the cutoff.

Results

TB of 13 mg/dL was associated with an increase in 90-day mortality (P = 0.043) and was the dominant risk factor on multivariate logistic regression [odds ratio (OR) 8.193, P = 0.001]. Increased TB levels were also associated with reoperations, number of complications per patient, and length of stay. Patients with TB greater than or equal to 13 mg/dL (TB ≥ 13) who received successful biliary decompression through stenting had less combined death and serious morbidity (P = 0.048).

Conclusions

Preoperative TB ≥ 13 mg/dL was associated with increased 90-day mortality after PD. Reducing a TB ≥ 13 is generally recommended before proceeding to surgery.

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Authors and Affiliations

  1. Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA

    Bofeng Chen BA, Maxwell T. Trudeau BA, Laura Maggino MD, Brett L. Ecker MD, Luke J. Keele PhD, Ronald P. DeMatteo MD, Jeffrey A. Drebin MD, PhD, Douglas L. Fraker MD, Major K. Lee IV MD, PhD, Robert E. Roses MD & Charles M. Vollmer Jr. MD

  2. Department of Surgery, University of Verona, The Pancreas Institute, Verona, Italy

    Laura Maggino MD

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Correspondence to Charles M. Vollmer Jr. MD.

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Chen, B., Trudeau, M.T., Maggino, L. et al. Defining the Safety Profile for Performing Pancreatoduodenectomy in the Setting of Hyperbilirubinemia. Ann Surg Oncol 27, 1595–1605 (2020). https://doi.org/10.1245/s10434-019-08044-w

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