Background: Pancreatoduodenectomy (PD) is the standard surgical approach for treating benign
and malignant pancreatic lesions. Preoperative hyperbilirubinemia has been associated
with adverse postoperative outcomes; however, the predictive significance of hypoalbuminemia
remains unclear. This study aims to assess the impact of preoperative serum albumin
and bilirubin levels on clinical outcomes in patients undergoing PD.
Methods: Patients who underwent partial or total PD at a single high-volume pancreatic surgery
center were identified from a prospectively maintained database. Patients were categorized
by preoperative serum albumin levels as normal (3.5–5 g/dL), mild hypoalbuminemia
(3.0–3.49 g/dL), and moderate/severe hypoalbuminemia (<3.0 g/dL). Preoperative bilirubin
levels were classified as mild (<10 mg/dL), moderate (10–15 mg/dL), or severe (>15
mg/dL). Postoperative complications, including pancreatic fistula (POPF), post-pancreatectomy
hemorrhage (PPH), and mortality were analyzed across groups.
Results: Among 1149 patients undergoing PD, mild and moderate/severe hypoalbuminemia were
observed in 42 and 32 patients, respectively. Moderate and severe hyperbilirubinemia
occurred in 64 (5.6%) and 24 (2.1%) patients, respectively. Patients with moderate/severe
hypoalbuminemia had significantly higher rates of grade C POPF (p<0.01) and PPH (p<0.01).
Mortality rates at 30 and 90 days were 18.8% and 25%, respectively, among these patients,
significantly higher than those with normal or mild hypoalbuminemia (p<0.01). Multivariate
analysis identified moderate/severe hypoalbuminemia as an independent predictor of
30-day (odds ratio 4.9, p=0.03) and 90-day mortality (odds ratio 9.8, p<0.01).
Conclusion: Moderate/severe preoperative hypoalbuminemia is independently associated with worse
outcomes, including increased postoperative complications and higher short-term mortality.
These findings highlight the importance of hypoalbuminemia compared to hyperbilirubinemia,
and emphasize the role preoperative optimization of nutritional and metabolic status
in preventing hazardous events for patients undergoing PD.
