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Pancreaticoduodenectomy after bilirubin adsorption for distal cholangiocarcinoma with severe obstructive jaundice refractory to repeat preoperative endoscopic biliary drainage: a case report

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Abstract

The necessity of biliary drainage before pancreaticoduodenectomy remains controversial in cases involving malignant obstructive jaundice; however, the benefits of biliary drainage have been reported in cases with severe hyperbilirubinemia. Herein, we present the case of a 61-year-old man suffering from jaundice due to distal cholangiocarcinoma. In this case, obstructive jaundice was refractory to repeat endoscopic drainage and bilirubin adsorption. Hyperbilirubinemia persisted despite successful implementation of biliary endoscopic sphincterotomy and two rounds of plastic stent placements. Stent occlusion and migration were unlikely and oral cholagogues proved ineffective. Owing to the patient’s surgical candidacy and his aversion to nasobiliary drainage due to discomfort, bilirubin adsorption was introduced as an alternative therapeutic intervention. Following repeated adsorption sessions, a gradual decline in serum total bilirubin levels was observed and pancreaticoduodenectomy was scheduled. The patient successfully underwent pancreaticoduodenectomy with portal vein resection and reconstruction and D2 lymph node dissection. After the surgery, the serum bilirubin levels gradually decreased and the patient remained alive, with no recurrence at 26 months postoperatively. Therefore, this case highlights the feasibility and safety of performing pancreaticoduodenectomy in patients with severe, refractory jaundice who have not responded to repeated endoscopic interventions and have partially responded to bilirubin adsorption.

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References

  1. van der Gaag NA, Rauws EAJ, van Eijck CHJ, et al. Preoperative biliary drainage for cancer of the head of the pancreas. N Engl J Med. 2010;362:129–37.

    Article  PubMed  Google Scholar 

  2. Chen B, Trudeau MT, Maggino L, et al. Defining the safety profile for performing pancreatoduodenectomy in the setting of hyperbilirubinemia. Ann Surg Oncol. 2020;27:1595–605.

    Article  PubMed  Google Scholar 

  3. Han SY, Kim S-O, So H, et al. EUS-guided biliary drainage versus ERCP for first-line palliation of malignant distal biliary obstruction: a systematic review and meta-analysis. Sci Rep. 2019;9:1–9.

    Article  Google Scholar 

  4. Nakatake R, Ishizaki M, Miyasaka C, et al. Hepatectomy in a case of hepatocellular carcinoma with constitutional indocyanine green excretory defect. Int J Surg Case Rep. 2018;53:231–4.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Aoki H, Morihiro T, Arata T, et al. Hepatectomy in a hepatocellular carcinoma case with Dubin-Johnson syndrome and indocyanine green excretory defect. Clin J Gastroenterol. 2013;6:69–74.

    Article  PubMed  Google Scholar 

  6. Liu W, Chen L-J, Jiang Y, et al. Hepatocellular carcinoma with indocyanine green excretory defect: a case report and review of the literature. J Int Med Res. 2021;49:3000605211004025.

    PubMed  Google Scholar 

  7. Sano K, Kubota K, Bandai Y, et al. Rate of bilirubin decrease as a risk predictor in hepato-biliary-pancreatic surgery. Hepatogastroenterology. 1999;46:2171–7.

    CAS  PubMed  Google Scholar 

  8. Fretzayas A, Moustaki M, Liapi O, et al. Gilbert syndrome. Eur J Pediatr. 2012;171:11–5.

    Article  CAS  PubMed  Google Scholar 

  9. Vítek L, Tiribelli C. Gilbert’s syndrome revisited. J Hepatol. 2023;79(4):1049–55.

    Article  PubMed  Google Scholar 

  10. Ye N, Zhou Z, Gong H, et al. Gilbert syndrome with systemic lupus erythematosus presenting with persistent unconjugated hyperbilirubinemia: a case report. Exp Ther Med. 2020;20:91.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Nagino M, Takada T, Miyazaki M, et al. Preoperative biliary drainage for biliary tract and ampullary carcinomas. J Hepatobiliary Pancreat Surg. 2008;15:25–30.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Iacono C, Ruzzenente A, Campagnaro T, et al. Role of preoperative biliary drainage in jaundiced patients who are candidates for pancreatoduodenectomy or hepatic resection: highlights and drawbacks. Ann Surg. 2013;257:191–204.

    Article  PubMed  Google Scholar 

  13. Dolejs S, Zarzaur BL, Zyromski NJ, et al. Does hyperbilirubinemia contribute to adverse patient outcomes following pancreatoduodenectomy? J Gastrointest Surg. 2017;21:647–56.

    Article  PubMed  Google Scholar 

  14. Srivastava S, Sikora SS, Kumar A, et al. Outcome following pancreaticoduodenectomy in patients undergoing preoperative biliary drainage. Dig Surg. 2001;18:381–7.

    Article  CAS  PubMed  Google Scholar 

  15. De Pastena M, Marchegiani G, Paiella S, et al. Impact of preoperative biliary drainage on postoperative outcome after pancreaticoduodenectomy: an analysis of 1500 consecutive cases. Dig Endosc. 2018;30:777–84.

    Article  PubMed  Google Scholar 

  16. Sauvanet A, Boher J-M, Paye F, et al. Severe jaundice increases early severe morbidity and decreases long-term survival after pancreaticoduodenectomy for pancreatic adenocarcinoma. J Am Coll Surg. 2015;221:380–9.

    Article  PubMed  Google Scholar 

  17. Jinkins LJ, Parmar AD, Han Y, et al. Current trends in preoperative biliary stenting in patients with pancreatic cancer. Surgery. 2013;154:179–89.

    Article  PubMed  Google Scholar 

  18. Ngu W, Jones M, Neal CP, et al. Preoperative biliary drainage for distal biliary obstruction and post-operative infectious complications. ANZ J Surg. 2013;83:280–6.

    Article  PubMed  Google Scholar 

  19. Koyama K, Takagi Y, Ito K, et al. Experimental and clinical studies on the effect of biliary drainage in obstructive jaundice. Am J Surg. 1981;142:293–9.

    Article  CAS  PubMed  Google Scholar 

  20. Eshuis WJ, van der Gaag NA, Rauws EAJ, et al. Therapeutic delay and survival after surgery for cancer of the pancreatic head with or without preoperative biliary drainage. Ann Surg. 2010;252:840–9.

    Article  PubMed  Google Scholar 

  21. Yokoyama Y, Nishio H, Ebata T, et al. Value of indocyanine green clearance of the future liver remnant in predicting outcome after resection for biliary cancer. Br J Surg. 2010;97:1260–8.

    Article  CAS  PubMed  Google Scholar 

  22. Iimuro Y. ICG clearance test and 99mTc-GSA SPECT/CT fusion images. Visc Med. 2017;33:449–54.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Kawamura H, Kamiyama T, Nakagawa T, et al. Preoperative evaluation of hepatic functional reserve by converted ICGR15 calculated from Tc-GSA scintigraphy. J Gastroenterol Hepatol. 2008;23:1235–41.

    Article  PubMed  Google Scholar 

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Acknowledgements

We thank the Department of Nephrology at our institution for providing bilirubin adsorption and the Department of Gastroenterology for conducting repeat ERCPs. This study was supported by Grants-in-Aid for Research from the National Center for Global Health and Medicine (21A-1019 to NT).

Funding

National Center for Global Health and Medicine, 21A-1019, Nobuyuki Takemura.

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Authors and Affiliations

  1. Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-Ku, Tokyo, 162-8655, Japan

    Toshihiro Nakayama, Kyoji Ito, Mai Nakamura, Fuyuki Inagaki, Fuminori Mihara, Nobuyuki Takemura & Norihiro Kokudo

  2. Department of Nephrology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-Ku, Tokyo, 162-8655, Japan

    Daisuke Katagiri

  3. Department of Gastroenterology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-Ku, Tokyo, 162-8655, Japan

    Natsuyo Yamamoto

Authors
  1. Toshihiro Nakayama
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  2. Kyoji Ito
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  3. Mai Nakamura
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  4. Fuyuki Inagaki
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  5. Daisuke Katagiri
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  6. Natsuyo Yamamoto
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  7. Fuminori Mihara
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  8. Nobuyuki Takemura
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  9. Norihiro Kokudo
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Contributions

TN, KI, and NT contributed to the conception and design of the study. All authors contributed to the acquisition and analysis of data. TN, KI, and NT were major contributors in writing the manuscript. All authors read and approved the final manuscript.

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Correspondence to Nobuyuki Takemura.

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The authors declare that they have no conflicts of interest.

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This article satisfied the consensus of the National Center for Global Health and Medicine Research Ethics Committee/Institutional Review Board.

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Written informed consent was obtained from the patient described in this study.

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Nakayama, T., Ito, K., Nakamura, M. et al. Pancreaticoduodenectomy after bilirubin adsorption for distal cholangiocarcinoma with severe obstructive jaundice refractory to repeat preoperative endoscopic biliary drainage: a case report. Clin J Gastroenterol (2024). https://doi.org/10.1007/s12328-024-01966-3

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  • DOI: https://doi.org/10.1007/s12328-024-01966-3

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