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Wu MJ, Chan YY, Chen MY, Hung YL, Kou HW, Tsai CY, Hsu JT, Yeh TS, Hwang TL, Jan YY, Wu CH, Liu NJ, Wang SY, Yeh CN. The Clinical Impact of Different Types of Preoperative Biliary Intervention on Postoperative Biliary Tract Infection of Patients Undergoing Pancreaticoduodenectomy. J Clin Med 2024; 13:4150. [PMID: 39064190 PMCID: PMC11278498 DOI: 10.3390/jcm13144150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/14/2024] [Accepted: 06/22/2024] [Indexed: 07/28/2024] Open
Abstract
Background: For patients with obstructive jaundice and who are indicated for pancreaticoduodenectomy (PD) or biliary intervention, either endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiography and drainage (PTCD) may be indicated preoperatively. However, the possibility of procedure-related postoperative biliary tract infection (BTI) should be a concern. We tried to evaluate the impact of ERCP and PTCD on postoperative BTI. Methods: Patients diagnosed from June 2013 to March 2022 with periampullary lesions and with PD indicated were enrolled in this cohort. Patients without intraoperative bile culture and non-neoplastic lesions were excluded. Clinical information, including demographic and laboratory data, pathologic diagnosis, results of microbiologic tests, and relevant infectious outcomes, was extracted from medical records for analysis. Results: One-hundred-and-sixty-four patients from the cohort (164/689) underwent preoperative biliary intervention, either ERCP (n = 125) or PTCD (n = 39). The positive yield of intraoperative biliary culture was significantly higher in patients who underwent ERCP than in PTCD (90.4% vs. 41.0%, p < 0.001). Although there was no significance, a trend of higher postoperative BTI (13.8% vs. 2.7%) and BTI-related septic shock (5 vs. 0, 4.0% vs. 0%) in the ERCP group was noticed. While the risk factors for postoperative BTI have not been confirmed, a trend suggesting a higher incidence of BTI associated with ERCP procedures was observed, with a borderline p-value (p = 0.05, regarding ERCP biopsy). Conclusions: ERCP in patients undergoing PD increases the positive yield of intraoperative biliary culture. PTCD may be the favorable option if preoperative biliary intervention is indicated.
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Affiliation(s)
- Min-Jung Wu
- Division of General Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (M.-J.W.); (Y.-Y.C.); (M.-Y.C.); (Y.-L.H.); (H.-W.K.); (C.-Y.T.); (J.-T.H.); (T.-S.Y.); (T.-L.H.); (Y.-Y.J.)
| | - Yung-Yuan Chan
- Division of General Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (M.-J.W.); (Y.-Y.C.); (M.-Y.C.); (Y.-L.H.); (H.-W.K.); (C.-Y.T.); (J.-T.H.); (T.-S.Y.); (T.-L.H.); (Y.-Y.J.)
| | - Ming-Yang Chen
- Division of General Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (M.-J.W.); (Y.-Y.C.); (M.-Y.C.); (Y.-L.H.); (H.-W.K.); (C.-Y.T.); (J.-T.H.); (T.-S.Y.); (T.-L.H.); (Y.-Y.J.)
| | - Yu-Liang Hung
- Division of General Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (M.-J.W.); (Y.-Y.C.); (M.-Y.C.); (Y.-L.H.); (H.-W.K.); (C.-Y.T.); (J.-T.H.); (T.-S.Y.); (T.-L.H.); (Y.-Y.J.)
| | - Hao-Wei Kou
- Division of General Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (M.-J.W.); (Y.-Y.C.); (M.-Y.C.); (Y.-L.H.); (H.-W.K.); (C.-Y.T.); (J.-T.H.); (T.-S.Y.); (T.-L.H.); (Y.-Y.J.)
| | - Chun-Yi Tsai
- Division of General Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (M.-J.W.); (Y.-Y.C.); (M.-Y.C.); (Y.-L.H.); (H.-W.K.); (C.-Y.T.); (J.-T.H.); (T.-S.Y.); (T.-L.H.); (Y.-Y.J.)
| | - Jun-Te Hsu
- Division of General Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (M.-J.W.); (Y.-Y.C.); (M.-Y.C.); (Y.-L.H.); (H.-W.K.); (C.-Y.T.); (J.-T.H.); (T.-S.Y.); (T.-L.H.); (Y.-Y.J.)
- Chang Gung University, Taoyuan 333, Taiwan;
| | - Ta-Sen Yeh
- Division of General Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (M.-J.W.); (Y.-Y.C.); (M.-Y.C.); (Y.-L.H.); (H.-W.K.); (C.-Y.T.); (J.-T.H.); (T.-S.Y.); (T.-L.H.); (Y.-Y.J.)
- Chang Gung University, Taoyuan 333, Taiwan;
| | - Tsann-Long Hwang
- Division of General Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (M.-J.W.); (Y.-Y.C.); (M.-Y.C.); (Y.-L.H.); (H.-W.K.); (C.-Y.T.); (J.-T.H.); (T.-S.Y.); (T.-L.H.); (Y.-Y.J.)
- Chang Gung University, Taoyuan 333, Taiwan;
| | - Yi-Yin Jan
- Division of General Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (M.-J.W.); (Y.-Y.C.); (M.-Y.C.); (Y.-L.H.); (H.-W.K.); (C.-Y.T.); (J.-T.H.); (T.-S.Y.); (T.-L.H.); (Y.-Y.J.)
- Chang Gung University, Taoyuan 333, Taiwan;
| | - Chi-Huan Wu
- Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan;
| | - Nai-Jen Liu
- Chang Gung University, Taoyuan 333, Taiwan;
- Department of Gastroenterology and Hepatology, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan;
| | - Shang-Yu Wang
- Division of General Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (M.-J.W.); (Y.-Y.C.); (M.-Y.C.); (Y.-L.H.); (H.-W.K.); (C.-Y.T.); (J.-T.H.); (T.-S.Y.); (T.-L.H.); (Y.-Y.J.)
- Chang Gung University, Taoyuan 333, Taiwan;
| | - Chun-Nan Yeh
- Division of General Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (M.-J.W.); (Y.-Y.C.); (M.-Y.C.); (Y.-L.H.); (H.-W.K.); (C.-Y.T.); (J.-T.H.); (T.-S.Y.); (T.-L.H.); (Y.-Y.J.)
- Chang Gung University, Taoyuan 333, Taiwan;
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Sakai H, Notake T, Shimizu A, Kubota K, Masuo H, Yoshizawa T, Hosoda K, Hayashi H, Yasukawa K, Soejima Y. Risk factors for postoperative cholangitis after pancreaticoduodenectomy and evaluation of internal stenting on hepaticojejunostomy: A single-center propensity score-based analysis. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2023; 30:1065-1077. [PMID: 36866510 DOI: 10.1002/jhbp.1322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/04/2023] [Accepted: 02/28/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND/PURPOSE This retrospective study aimed to investigate the risk factors for postoperative cholangitis (POC) after pancreaticoduodenectomy (PD) and the efficacy of stenting on hepaticojejunostomy (HJ). METHODS We investigated 162 patients. Postoperative cholangitis occurring before and after discharge was defined as early-onset POC (E-POC) and late-onset POC (L-POC), respectively. Risk factors for E-POC and L-POC were identified using univariate and multivariate logistic regression analyses. Propensity score matching (PSM) between the stenting group (group S) and the non-stenting group (group NS), and subgroup analysis in patients with risk factors were performed to evaluate the efficacy of stenting on HJ in preventing POC. RESULTS Body mass index (BMI) ≥ 25 kg/m2 and preoperative non-biliary drainage (BD) were risk factors for E-POC and L-POC, respectively. PSM analysis revealed that E-POC occurrence was significantly higher in group S than in group NS (P = .045). In the preoperative non-BD group (n = 69), E-POC occurrence was significantly higher in group S than in group NS (P = .025). CONCLUSIONS BMI ≥ 25 kg/m2 and preoperative non-BD status were risk factors for E-POC and L-POC, respectively. Stenting on HJ implants did not prevent POC after PD.
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Affiliation(s)
- Hiroki Sakai
- Department of Surgery, Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Tsuyoshi Notake
- Department of Surgery, Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Akira Shimizu
- Department of Surgery, Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Koji Kubota
- Department of Surgery, Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hitoshi Masuo
- Department of Surgery, Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takahiro Yoshizawa
- Department of Surgery, Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kiyotaka Hosoda
- Department of Surgery, Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hikaru Hayashi
- Department of Surgery, Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Koya Yasukawa
- Department of Surgery, Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yuji Soejima
- Department of Surgery, Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Shinshu University School of Medicine, Matsumoto, Japan
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Hammad AY, Khachfe HH, AlMasri S, DeSilva A, Liu H, Nassour I, Lee K, Zureikat AH, Paniccia A. Impact of Extended Antibiotic Use After Pancreaticoduodenectomy for Patients with Preoperative Metallic Biliary Stenting Treated with Neoadjuvant Chemotherapy. J Gastrointest Surg 2023; 27:716-723. [PMID: 36650416 PMCID: PMC11234506 DOI: 10.1007/s11605-023-05581-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/22/2022] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Pancreaticoduodenectomy (PD) remains a complex surgical procedure with infectious complications affecting nearly 50% of patients. Patients who undergo biliary drainage with stent placement prior to neoadjuvant treatment (NAT) reportedly have higher infection rates following PD. The aim of the current study is to evaluate the differences in postoperative infectious complication rates based on the duration of post operative prophylactic antibiotics in patients with indwelling metal biliary stent who had NAT. METHODS A retrospective institutional pancreatic cancer database was queried for patients who had a metal biliary stent placed prior to NAT initiation, followed by subsequent PD between 2014 and 2021. Duration of postoperative prophylactic antibiotics was defined as short (SC: ≤ 24 h) or extended (EC: > 24 h-7 days). The primary outcome of interest was surgical site infection (SSI). RESULTS Two hundred and ninety-five (n = 295) patients were identified of which the majority (n = 205, 69.5%) received a short course of antibiotics postoperatively. Baseline characteristics were similar between the two cohorts including age, sex, BMI, and comorbidity index. EC patients received more NAT cycles (4 vs. 3, p < 0.001) and underwent an open PD more frequently (61.8% vs. 41.0%, p < 0.001). SSI occurred in 64 (21.7%) patients; SC cohort: 54, 26.3% vs. EC cohort:10, 11.1%, (p = 0.003). Additionally, the SC cohort demonstrated a higher incidence of major complications (Clavien-Dindo ≥ 3: 51 [24.9%] vs. 13 [14.4%], p = 0.045). On the logistic regression model examining factors associated with SSI, higher BMI (continuous variable) was associated with increased odds of SSI (OR: 1.05 [95%CI: 1.00, 1.10, p = 0.040), while EC was protective (OR: 0.36 [95%CI: 0.17, 0.75], p = 0.007). CONCLUSIONS These data suggest that an extended course of perioperative antibiotic correlates with reductions in SSI and major morbidity following PD in patients with a metallic biliary stent placed prior to NAT course. These results require validation in a future randomized clinical trial examining a larger cohort of patients with further emphasis on the types of perioperative antibiotics administered.
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Affiliation(s)
- Abdulrahman Y Hammad
- Division of GI Surgical Oncology, Department of Surgery, University of Pittsburgh Medical Center, UPMC Cancer Pavilion, 3550 Terrace Street, A425 Scaife Hall, Pittsburgh, PA, USA
| | - Hussein H Khachfe
- Division of GI Surgical Oncology, Department of Surgery, University of Pittsburgh Medical Center, UPMC Cancer Pavilion, 3550 Terrace Street, A425 Scaife Hall, Pittsburgh, PA, USA
| | - Samer AlMasri
- Division of GI Surgical Oncology, Department of Surgery, University of Pittsburgh Medical Center, UPMC Cancer Pavilion, 3550 Terrace Street, A425 Scaife Hall, Pittsburgh, PA, USA
| | - Annissa DeSilva
- Division of GI Surgical Oncology, Department of Surgery, University of Pittsburgh Medical Center, UPMC Cancer Pavilion, 3550 Terrace Street, A425 Scaife Hall, Pittsburgh, PA, USA
| | - Hao Liu
- Division of GI Surgical Oncology, Department of Surgery, University of Pittsburgh Medical Center, UPMC Cancer Pavilion, 3550 Terrace Street, A425 Scaife Hall, Pittsburgh, PA, USA
| | - Ibrahim Nassour
- Division of GI Surgical Oncology, Department of Surgery, University of Pittsburgh Medical Center, UPMC Cancer Pavilion, 3550 Terrace Street, A425 Scaife Hall, Pittsburgh, PA, USA
| | - Kenneth Lee
- Division of GI Surgical Oncology, Department of Surgery, University of Pittsburgh Medical Center, UPMC Cancer Pavilion, 3550 Terrace Street, A425 Scaife Hall, Pittsburgh, PA, USA
| | - Amer H Zureikat
- Division of GI Surgical Oncology, Department of Surgery, University of Pittsburgh Medical Center, UPMC Cancer Pavilion, 3550 Terrace Street, A425 Scaife Hall, Pittsburgh, PA, USA
| | - Alessandro Paniccia
- Division of GI Surgical Oncology, Department of Surgery, University of Pittsburgh Medical Center, UPMC Cancer Pavilion, 3550 Terrace Street, A425 Scaife Hall, Pittsburgh, PA, USA.
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Bineshfar N, Malekpour Alamdari N, Rostami T, Mirahmadi A, Zeinalpour A. The effect of preoperative biliary drainage on postoperative complications of pancreaticoduodenectomy: a triple center retrospective study. BMC Surg 2022; 22:399. [DOI: 10.1186/s12893-022-01853-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/14/2022] [Indexed: 11/19/2022] Open
Abstract
Abstract
Background
Biliary obstruction which is a major complication of pancreas and periampullary tumors could result in cholangitis, coagulopathies, gastrointestinal symptoms, and impaired wound healing. Pancreaticoduodenectomy (PD) is still the standard approach for pancreas resection and imposes high risk of morbidity and mortality to patients. To reduce the high risk of PD and address the biliary obstruction, the use of preoperative biliary stenting was increased. However, available literature doubts its efficiency.
Methods
A total of 147 patients who underwent PD between September 2012, and February 2022, at three medical centers were identified. Patients were grouped based on biliary stent placement. Non-jaundiced patients with and without preoperative biliary drainage (PBD) were compared.
Results
The incidence of overall complications (34.2% versus 45.8%) and mortality (17.8% versus 24.3%) did not differ in the PBD group compared to the no PBD group. There was no difference in complications and mortality in non-jaundiced patients with and without PBD. Patients with drainage duration of > 30 days experienced more overall complications compared to patients with less than 30 days drainage duration (12 (50.0%) and three (15.8%) patients, respectively, p-value = 0.019).
Conclusions
PBD does not significantly increase the post-operative burden on patients who undergo PD. However, we cannot overlook the financial burden that PBD places on the patient and the healthcare system, as well as the difficulties related to endoscopic retrograde cholangiopancreatography (ERCP). Therefore, biliary stenting should not be routinely practiced in the absence of a valid indication, such as severe jaundice, pruritus, cholangitis, delayed surgery for neoadjuvant treatment, or referral to a tertiary facility.
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Incarbone N, Gonta A, Antonucci A. Response to "impact of preoperative biliary drainage (PBD) on 30-day outcome of patients undergoing pancreaticoduodenectomy for malignancy". HPB (Oxford) 2022; 24:1818. [PMID: 35871135 DOI: 10.1016/j.hpb.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 06/29/2022] [Accepted: 07/04/2022] [Indexed: 12/12/2022]
Affiliation(s)
| | - Ana Gonta
- Department of General Surgery, Sant'Anna Hospital, Como, Italy
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