Preoperative bilirubin normalization and outcomes after pancreaticoduodenectomy in patients with predominantly mild-to-moderate obstructive jaundice due to periampullary tumors

Yusuf Yunus Korkmaz; İlyas Kudaş; Feyyaz Güngör; Oğuzhan Aydın; Murat Altay; Özgür Bostancı; Erdem Kınacı

doi:10.32322/jhsm.1884689

Preoperative bilirubin normalization and outcomes after pancreaticoduodenectomy in patients with predominantly mild-to-moderate obstructive jaundice due to periampullary tumors

Abstract

Aims: Pancreaticoduodenectomy remains the cornerstone of curative treatment for periampullary tumors but is associated with substantial postoperative morbidity. Obstructive jaundice is common in this setting and has traditionally been regarded as a risk factor warranting delay of surgery until biochemical normalization of bilirubin. However, evidence supporting this strategy remains conflicting, particularly in patients with mild to moderate hyperbilirubinemia. Methods: This retrospective single-center cohort study screened 295 consecutive patients who underwent pancreaticoduodenectomy for suspected periampullary tumors between June 2020 and August 2025. To specifically evaluate the impact of cholestasis, patients without preoperative hyperbilirubinemia were excluded. The final study cohort comprised 197 patients with cholestasis-associated periampullary tumors, including patients operated on with elevated bilirubin levels and those who underwent preoperative biliary drainage due to bilirubin elevation. Preoperative total bilirubin, C-reactive protein (CRP), and white blood cell count were recorded within 72 hours prior to surgery. Postoperative morbidity was assessed using the Clavien–Dindo classification, with overall morbidity defined as Clavien–Dindo grade ≥1 and major morbidity as Clavien Dindo grade ≥3. Bilirubin was evaluated both as a continuous variable and using clinically relevant cut-off values. Multivariable analyses were performed to identify independent associations with postoperative outcomes. Results: The mean preoperative total bilirubin level was 3.01±2.91 mg/dl. Preoperative bilirubin levels were not independently associated with overall morbidity, major morbidity, or postoperative mortality across multiple thresholds (≥2 mg/dl, >5 mg/dl, and >10 mg/dl). Similarly, the combined elevation of bilirubin and CRP did not predict increased postoperative morbidity or mortality. However, a more selective inflammatory cholestasis phenotype (bilirubin >5 mg/dl and CRP ≥10 mg/L) was independently associated with prolonged hospital stay after adjustment for age and American Society of Anesthesiologists (ASA) physical status. Conclusion: In this cohort of patients with cholestasis-associated periampullary tumors, preoperative hyperbilirubinemia—alone or combined with inflammatory markers—was not associated with increased postoperative morbidity or mortality after pancreaticoduodenectomy. These findings suggest that, in clinically stable patients with mild to moderate obstructive jaundice, delaying surgery solely to achieve biochemical normalization of bilirubin may not be necessary. Preoperative cholestasis and inflammation may be more informative for anticipating postoperative recovery patterns than for determining surgical eligibility.

Keywords

Supporting Institution

This study did not receive any financial or institutional support.

Project Number

Not applicable

Ethical Statement

This study was approved by the Istanbul Başakşehir Çam and Sakura City Hospital Ethics Committee (Date: 17.12.2025, Decision No: 444). Because the study was designed retrospectively, no written informed consent was obtained from the patients.

Thanks

Not applicable

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Details

Primary Language

English

Subjects

Oncologic Surgery, Gastroenterology Surgery, General Surgery

Journal Section

Research Article

Authors

Yusuf Yunus Korkmaz ^*
0000-0002-2032-0904
Türkiye

İlyas Kudaş
0000-0002-1319-9114
Türkiye

Feyyaz Güngör
0000-0002-4066-6072
Türkiye

Oğuzhan Aydın
0000-0003-3830-7086
Türkiye

Murat Altay
0000-0002-4023-4923
Türkiye

Özgür Bostancı
0000-0002-6336-0420
Türkiye

Erdem Kınacı
0000-0002-0380-7585
Türkiye

Publication Date

March 12, 2026

Submission Date

February 8, 2026

Acceptance Date

March 7, 2026

Published in Issue

Year 2026 Volume: 9 Number: 2

DOI

https://doi.org/10.32322/jhsm.1884689

IZ

https://izlik.org/JA55NT72NM

Cite

RIS / Bibtex

APA

Korkmaz, Y. Y., Kudaş, İ., Güngör, F., Aydın, O., Altay, M., Bostancı, Ö., & Kınacı, E. (2026). Preoperative bilirubin normalization and outcomes after pancreaticoduodenectomy in patients with predominantly mild-to-moderate obstructive jaundice due to periampullary tumors. Journal of Health Sciences and Medicine, 9(2), 530-536. https://doi.org/10.32322/jhsm.1884689

AMA

1.Korkmaz YY, Kudaş İ, Güngör F, et al. Preoperative bilirubin normalization and outcomes after pancreaticoduodenectomy in patients with predominantly mild-to-moderate obstructive jaundice due to periampullary tumors. J Health Sci Med / JHSM. 2026;9(2):530-536. doi:10.32322/jhsm.1884689

Chicago

Korkmaz, Yusuf Yunus, İlyas Kudaş, Feyyaz Güngör, et al. 2026. “Preoperative Bilirubin Normalization and Outcomes After Pancreaticoduodenectomy in Patients With Predominantly Mild-to-Moderate Obstructive Jaundice Due to Periampullary Tumors”. Journal of Health Sciences and Medicine 9 (2): 530-36. https://doi.org/10.32322/jhsm.1884689.

EndNote

Korkmaz YY, Kudaş İ, Güngör F, Aydın O, Altay M, Bostancı Ö, Kınacı E (March 1, 2026) Preoperative bilirubin normalization and outcomes after pancreaticoduodenectomy in patients with predominantly mild-to-moderate obstructive jaundice due to periampullary tumors. Journal of Health Sciences and Medicine 9 2 530–536.

IEEE

[1]Y. Y. Korkmaz et al., “Preoperative bilirubin normalization and outcomes after pancreaticoduodenectomy in patients with predominantly mild-to-moderate obstructive jaundice due to periampullary tumors”, J Health Sci Med / JHSM, vol. 9, no. 2, pp. 530–536, Mar. 2026, doi: 10.32322/jhsm.1884689.

ISNAD

Korkmaz, Yusuf Yunus - Kudaş, İlyas - Güngör, Feyyaz - Aydın, Oğuzhan - Altay, Murat - Bostancı, Özgür - Kınacı, Erdem. “Preoperative Bilirubin Normalization and Outcomes After Pancreaticoduodenectomy in Patients With Predominantly Mild-to-Moderate Obstructive Jaundice Due to Periampullary Tumors”. Journal of Health Sciences and Medicine 9/2 (March 1, 2026): 530-536. https://doi.org/10.32322/jhsm.1884689.

JAMA

1.Korkmaz YY, Kudaş İ, Güngör F, Aydın O, Altay M, Bostancı Ö, Kınacı E. Preoperative bilirubin normalization and outcomes after pancreaticoduodenectomy in patients with predominantly mild-to-moderate obstructive jaundice due to periampullary tumors. J Health Sci Med / JHSM. 2026;9:530–536.

MLA

Korkmaz, Yusuf Yunus, et al. “Preoperative Bilirubin Normalization and Outcomes After Pancreaticoduodenectomy in Patients With Predominantly Mild-to-Moderate Obstructive Jaundice Due to Periampullary Tumors”. Journal of Health Sciences and Medicine, vol. 9, no. 2, Mar. 2026, pp. 530-6, doi:10.32322/jhsm.1884689.

Vancouver

1.Yusuf Yunus Korkmaz, İlyas Kudaş, Feyyaz Güngör, Oğuzhan Aydın, Murat Altay, Özgür Bostancı, Erdem Kınacı. Preoperative bilirubin normalization and outcomes after pancreaticoduodenectomy in patients with predominantly mild-to-moderate obstructive jaundice due to periampullary tumors. J Health Sci Med / JHSM. 2026 Mar. 1;9(2):530-6. doi:10.32322/jhsm.1884689