Effect of preoperative biliary drainage on surgical results after pancreaticoduodenectomy in patients with distal common bile duct cancer: Focused on the rate of decrease in serum bilirubin

Table 1 Patient characteristics n (%)

Demographics	Total	Uncomplicated	Complicated	P
	(n = 49)	(n = 26)	(n = 23)
Age (yr)	64.0 ± 8.9	62.0 ± 9.9	65.5 ± 7.3	0.228
Sex				0.475
Male	36 (73.5)	18 (69.2)	18 (78.3)
Female	13 (26.5)	8 (30.8)	5 (21.7)
Diabetes				0.483
Yes	10 (20.4)	4 (15.4)	6 (26.1)
No	39 (79.6)	22 (84.6)	17 (73.9)
Operation				0.879
Whipple procedure	24 (49.0)	13 (50.0)	11 (47.8)
PPPD	25 (51.0)	13 (50.0)	12 (52.2)
Biliary drainage				0.472
Yes	40 (81.6)	20 (76.9)	20 (87.0)
No	9 (18.4)	6 (23.1)	3 (13.0)
1Leukocytosis				1.000
Yes	4 (8.2)	2 (7.7)	2 (8.7)
No	45 (91.8)	24 (92.3)	21 (91.3)
Bilirubin (&mgr;mol/L)	116.3 ± 92.3	107.7 ± 92.0	124.8 ± 97.5	0.652
Albumin (g/L)	34.2 ± 4.3	34.0 ± 4.4	34.4 ± 4.4	0.912
Creatinine (&mgr;mol/L)	70.7 ± 17.7	70.7 ± 26.5	70.7 ± 17.7	0.481
Alkaline phosphatase (U/L)	601 ± 450	632 ± 544	565 ± 322	0.764
Hemoglobin (g/L)	121.0 ± 16.5	117.8 ± 14.6	124.7 ± 18.0	0.193
Hematocrit (%)	35.6 ± 4.8	34.8 ± 4.3	36.4 ± 5.3	0.307
Operation data
Red cell transfusion (mL)	522 ± 401	442 ± 358	613 ± 435	0.116
Operation time (min)	515 ± 107	510 ± 104	520 ± 111	0.825

¹Defined as leukocyte count more than 10.8 × 10³/mm³. All laboratory values are preoperative serum levels expressed as mean ± SD, unless specified otherwise. PPPD: Pylorus preserving pancreaticoduodenectomy.

Table 2 Surgical morbidity and mortality n (%)

Morbidity and mortality	Number of patients
1Morbidity	23 (46.9)
Bleeding	4 (8.2)
Intraabdominal abscess	6 (12.2)
Pancreatic fistula	7 (14.3)
Delayed gastric emptying	7 (14.3)
Pulmonary complication	2 (4.1)
Mortality	3 (6.1)
Bleeding, DIC	2 (4.1)
Intraabdominal abscess, sepsis	1 (2.0)

¹A patient may have more than one complication. DIC: Disseminated intravascular coagulation.

Table 3 Analysis of preoperative biliary drainage-related factors n (%)

Factors	Total	Uncomplicated	Complicated	P
	(n = 40)	(n = 20)	(n = 20)
Drainage methods				0.723
ENBD	29 (72.5)	15 (75.0)	14 (70.0)
PTBD	11 (27.5)	5 (25.0)	6 (30.0)
Initial bilirubin (Bi)	229.1 ± 135.1	210.3 ± 157.3	246.2 ± 111.2	0.223
(&mgr;mol/L)
Preop. bilirubin (Bo)	131.7 ± 92.3	123.1 ± 94.1	140.2 ± 94.1	0.552
(&mgr;mol/L)
Duration of	10 ± 9	8 ± 5	12 ± 12	0.392
drainage (d)
Decrease in bilirubin	95.8 ± 104.3	87.2 ± 94.1	104.3 ± 114.6	0.715
(Bi–Bo, dB, &mgr;mol/L)
Ratio of decrease	0.37 ± 0.35	0.37 ± 0.31	0.38 ± 0.40	0.892
in bilirubin (dB/Bi)
Rate of decrease	10.1 ± 16.6	13.2 ± 14.5	7.0 ± 18.1	0.425
in bilirubin
(dB/d, &mgr;mol/L)
Bpod1 (&mgr;mol/L)	1.9 ± 8.6	4.4 ± 5.4	-0.6 ± 10.3	0.180
Bpod2 (&mgr;mol/L)	2.2 ± 9.1	4.4 ± 5.8	-0.1 ± 11.2	0.228

Variables are presented as mean ± SD, unless specified otherwise. ENBD: Endoscopic nasobiliary drainage; PTBD: Percutaneous transhepatic biliary drainage; Bpod1: Decrease in serum bilirubin during the first postoperative week; Bpod2: Decrease in serum bilirubin during the second postoperative week.

Table 4 Rate of decrease in serum bilirubin after preoperative biliary drainage n (%)

Factors	Total (n = 40)	Fast decrease group (n = 20)	Slow decrease group (n = 20)	P
Drainage methods				0.723
ENBD	29 (72.5)	14 (70)	15 (75)
PTBD	11 (27.5)	6 (30)	5 (25)
Complication				0.527
Uncomplicated	20 (50)	11 (55)	9 (45)
Complicated	20 (50)	9 (45)	11 (50)
Bpod1 (&mgr;mol/L)	1.9 ± 8.6	5.5 ± 4.4	-1.7 ± 9.9	0.004
Bpod2 (&mgr;mol/L)	2.2 ± 9.1	1.9 ± 4.3	2.4 ± 12.3	0.818

Variables are presented as mean ± SD, unless specified otherwise. ENBD: Endoscopic nasobiliary drainage; PTBD: percutaneous transhepatic biliary drainage; Bpod1: decrease in serum bilirubin during the first postoperative week; Bpod2: decrease in serum bilirubin during the second postoperative week.