Inclusion Criteria:  Patients ≥ 18 years OJ of malignant origin (pancreatic head or periampullary tumor) Total bilirubin level ≥ 40 μmol per liter Signed written informed consent  Exclusion Criteria:  Proved metastasis Irresectable tumor Neo-adjuvant chemotherapy Co-existing malignancy Pregnancy Patients not fit for resection