Liver function analysis according to the serum bilirubin decreasing rate of preoperative biliary drainage

Objective: To investigate the relationship between liver function and bilirubin decreasing response of preoperative biliary drainage for obstructive jaundice in perihilar biliary tumor patients. Methods: Twenty-five patients who underwent surgical treatment for perihilar biliary tumor between January 2014 and August 2016 were included. Among them, 11 patients had obstructive jaundice (jaundice group) and remaining 14 patients had no jaundice (no-jaundice group). All patients in jaundice group underwent preoperative biliary drainage. To evaluate the bilirubin decreasing response, we defined bilirubin decreasing rate (BDR) as follow; BDR=(difference of serum bilirubin value between before and after drainage)/drainage duration. Preoperative liver function was investigated using indocyanine green retention rate at 15 minutes (ICGR15), the clearance index (HH15) and hepatic uptake ratio (LHL15) of 99mTc-galactosyl human serum albumin liver scintigraphy. Results: Among 25 patients, 22 underwent extended hemi-lobectomy (4 right and 18 left), 2 underwent left trisectionectomy, and 1 underwent limited liver resection with pancreatoduodenectomy. Drainage duration was 9 days (1–59) and BDR was 12.7 μmol/L/day (3.4–37.6). Although preoperative liver function was not significantly different between jaundice group and non-jaundice group, BDR was strongly correlated with preoperative liver function (r=−0.587, 0.775, −0.422 in ICGR15, HH15 and LHL15, respectively), the patients with lower BDR were tended to be lower liver function. BDR was also strongly correlated with postoperative bilirubin increasing value (r=−0.694, P=0.018), the patients with lower BDR were tended to be higher bilirubin increasing value. Conclusion: The patients in jaundice group with lower BDR were suspected to be lower liver function.