To evaluate the effect of preoperative reduction of jaundice in pancreaticoduodenectomy for patients with moderate malignant obstructive jaundice.

Clinical data of 86 patients with periampullary carcinoma complicated with moderate obstructive jaundice who underwent pancreaticoduodenectomy in the First Affiliated Hospital of Dalian Medical University from May 2011 to August 2019 were retrospectively analyzed. Among them, 55 patients were male and 31 female, aged 32-76 years with a median age of 61 years. The informed consents of all patients were obtained and the local ethical committee approval was received. Upon admission, the serum total bilirubin (TB) levels of patients were ranged from 171 to 342 μmol/L. All patients were divided into the jaundice reduction group (n=36) and non-jaundice reduction group (n=50). Perioperative conditions were statistically compared between two groups by using t test or rank-sum test. The incidence of complications was compared by Chi-square test.

The incidence of complications induced by preoperative jaundice reduction was 22%(8/36), including 3 cases of biliary infection, 2 cases of pancreatitis, 2 cases of electrolyte disturbance and 1 case of biliary peritonitis. In jaundice reduction group, the mean TB level was (103±58) μmol/L, significantly lower than (256±49) μmol/L before jaundice reduction (t=-12.145, P<0.05). The ALT and AST levels after jaundice reduction were 84(58, 108) and 54(41, 84) U/L, significantly lower compared with 208(72, 348) and 135 (65, 209) U/L before jaundice reduction (Z=-3.672, -3.886; P<0.05). In jaundice reduction group, the incidence of complications after pancreaticoduodenectomy was 50%(18/36), which did not differ from 56%(28/50) in the non-jaundice reduction group (χ²=0.303, P>0.05).

For the patients with moderate malignant obstructive jaundice undergoing pancreaticoduodenectomy, preoperative jaundice reduction can improve liver function, whereas it brings no benefits to the postoperative prognosis of patients and increases the incidence of operation-related complications. Surgery should be performed as soon as the diagnosis is confirmed.