The optimal preoperative bilirubin level before pancreaticoduodenectomy for distal cholangiocarcinoma

Introduction It is currently unclear what the optimal level of preoperative bilirubin is for pancreaticoduodenectomy(PD) to reduce severe complications. The aim of this study is to identify the optimal bilirubin level of patients with hyperbilirubinemia undergoing PD. Methods Receiver operating characteristic (ROC) curve(AUC) based on the highest Youden index was used to determine cut-off value of the optimal preoperative bilirubin that were associated with increases in 90-day mortality. Subgroup comparisons analyses were performed for patients with preoperative bilirubin according to the cut-off value. Results Preoperative bilirubin > 163 µmol/L was associated with an increase in 90-day mortality rate(P = 0.001). Significantly more patients with preoperative bilirubin > 163 µmol/L had biliary leakage (16.39% vs 3.7%; p = 0.026). Although there were more infections, postoperative bleeding and transfusion, delayed gastric emptying, reoperation, ICU use and pancreatic fistula in patients with preoperative bilirubin > 163 µmol/L compared to ≤ 163 µmol/L, there was no statistically significant difference. Disease-free survival did not differ much between the two groups (p = 0.418). The 5-year overall survival rate was 23.4% in patients with preoperative bilirubin ≤ 163 µmol/L and 16.2% in patients with preoperative bilirubin > 163 µmol/L, overall survival was significantly better in patients with preoperative bilirubin ≤ 163 µmol/L (p < 0.05). Conclusions The cut-off value of preoperative bilirubin level of 163 µmol/L is recommended, as the study showed that preoperative bilirubin level ≤ 163 µmol/L significantly reduced the 90-day mortality, complications and got better survival after PD for distal cholangiocarcinoma.