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Ramírez-Arbeláez JA, Arroyave-Zuluaga RL, Barrera-Lozano LM, Hurtado V, González-Arroyave D, Ardila CM. Relationship between Intraoperative Bile Culture Outcomes and Subsequent Postoperative Infectious Complications: A Retrospective Cohort Study. BIOMED RESEARCH INTERNATIONAL 2024; 2024:3930130. [PMID: 38803514 PMCID: PMC11129905 DOI: 10.1155/2024/3930130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 04/15/2024] [Accepted: 04/25/2024] [Indexed: 05/29/2024]
Abstract
The presence of positive bile culture during intraoperative procedures has been associated with elevated morbidity and mortality rates in hepatobiliopancreatic surgeries, contributing to increased healthcare expenditures. However, the precise impact of bactobilia on the development of postoperative complications remains uncertain due to existing disparities in the published literature. In this retrospective cohort study, we assessed 137 patients who underwent major hepatobiliopancreatic surgery to examine the relationship between intraoperative bile culture outcomes and subsequent postoperative infectious complications. Among patients with bactobilia, a significant 35.1% exhibited systemic or local infectious complications, whereas only 11.1% of those with negative culture results experienced any infectious complications (p = 0.002). Similarly, a notable difference was observed in the incidence of surgical site infections, with 24.3% in the bactobilia group compared to 7.9% in the negative culture group (p = 0.01). A total of 74 monomicrobial cultures with microbiological growth were isolated, predominantly featuring Gram-negative microorganisms, primarily Enterobacteriaceae in 49 cultures. Escherichia coli was identified in 37.8% of positive cultures, while Klebsiella pneumoniae was evident in 21.6%. Gram-positive microorganisms were present in 10 cultures, with Enterococcus emerging as the prevailing species. The logistic regression model identified a positive bile culture as an independent factor significantly associated with infection development (OR: 2.26; 95% confidence interval: 1.23-11; p = 0.02). Considering the limitations of the study, these findings underscore the critical importance of conducting bile cultures during the intraoperative phase to enable vigilant monitoring and prompt management of infectious complications.
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Affiliation(s)
| | | | - Luis Manuel Barrera-Lozano
- Department of Transplants, Hospital San Vicente Fundación, Rionegro, Colombia
- Department of General Surgery, Universidad de Antioquia UdeA, Medellín, Colombia
| | - Verónica Hurtado
- Department of Transplants, Hospital San Vicente Fundación, Rionegro, Colombia
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2
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Amaral MJ, Freitas J, Amaral M, Serôdio M, Oliveira RC, Donato P, Tralhão JG. Clinical Impact of Preoperative Biliary Drainage in Patients with Ductal Adenocarcinoma of the Pancreatic Head. Diagnostics (Basel) 2023; 13:diagnostics13071281. [PMID: 37046501 PMCID: PMC10093239 DOI: 10.3390/diagnostics13071281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/24/2023] [Accepted: 03/21/2023] [Indexed: 03/31/2023] Open
Abstract
Our aim was to study the association between preoperative biliary drainage (PBD) and morbidity following cephalic pancreaticoduodenectomy (CPD) for pancreatic ductal adenocarcinoma (PDAC) and its prognostic impact, which is still controversial in the literature. A retrospective study was conducted, which included 128 patients who underwent CPD for PDAC, divided into two groups: those who underwent PBD (group 1) and those who did not undergo this procedure (group 2). Group 1 was subdivided according to the drainage route: endoscopic retrograde cholangiopancreatography (ERCP), group 1.1, and percutaneous transhepatic cholangiography (PTC), group 1.2. 34.4% of patients underwent PBD, and 47.7% developed PBD-related complications, with 37% in group 1.1 and 64.7% in group 1.2 (p = 0.074). There was a significant difference between group 1 and 2 regarding bacterial colonization of the bile (45.5% vs. 3.6%, p < 0.001), but no difference was found in the colonization by multidrug-resistant bacteria, the development of Clavien–Dindo ≥ III complications, clinically relevant pancreatic fistula and delayed gastric emptying (DGE), intra-abdominal abscess, hemorrhage, superficial surgical site infection (SSI), and readmission. Between groups 1.1 and 1.2, there was a significant difference in clinically relevant DGE (44.4% vs. 5.9%, p = 0.014) and Clavien–Dindo ≥ III complications (59.3% vs. 88.2%, p = 0.040). There were no significant differences in median overall survival and disease-free survival (DFS) between groups 1 and 2. Groups 1.1 and 1.2 had a significant difference in DFS (10 vs. 5 months, p = 0.017). In this group of patients, PBD was associated with increased bacterial colonization of the bile, without a significant increase in postoperative complications or influence in survival. ERCP seems to contribute to the development of clinically significant DGE. Patients undergoing PTC appear to have an early recurrence.
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Affiliation(s)
- Maria João Amaral
- General Surgey Department, Centro Hospitalar e Universitário de Coimbra, 3000-075 Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
- Correspondence:
| | - João Freitas
- Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
| | - Mariana Amaral
- Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
| | - Marco Serôdio
- General Surgey Department, Centro Hospitalar e Universitário de Coimbra, 3000-075 Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
| | - Rui Caetano Oliveira
- Pathology Department, Centro Hospitalar e Universitário de Coimbra, 3000-075 Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), 3000-075 Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR) Area of Environment, Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
| | - Paulo Donato
- Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
- Radiology Department, Centro Hospitalar e Universitário de Coimbra, 3000-075 Coimbra, Portugal
| | - José Guilherme Tralhão
- General Surgey Department, Centro Hospitalar e Universitário de Coimbra, 3000-075 Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR) Area of Environment, Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
- Radiology Department, Centro Hospitalar e Universitário de Coimbra, 3000-075 Coimbra, Portugal
- Biophysics Institute, Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
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3
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Aitken RJ. Pancreaticoduodenectomy in Australia: a national quality improvement clinical registry is long overdue. ANZ J Surg 2022; 92:6-8. [PMID: 35212115 DOI: 10.1111/ans.17395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 11/16/2021] [Indexed: 12/15/2022]
Affiliation(s)
- R James Aitken
- Department of General Surgery, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
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4
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Gong S, Song S, Cheng Q, Huang Y, Tian H, Jing W, Lei C, Yang W, Yang K, Guo T. Efficacy and safety of preoperative biliary drainage in patients undergoing pancreaticoduodenectomy: an updated systematic review and meta-analysis. Expert Rev Gastroenterol Hepatol 2021; 15:1411-1426. [PMID: 34886725 DOI: 10.1080/17474124.2021.2013805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES This study aimed to evaluate the effect of preoperative biliary drainage (PBD) on outcomes of pancreaticoduodenectomy (PD) in patients with biliary obstruction. METHODS We searched PubMed, EMBASE, Cochrane library, and Web of Science from database inception to 11 March 2021. We used the ROBINS-I tool and Cochrane risk of bias tool 2.0 to assess the risk of bias. The data were statistically analyzed using the RevMan software (Version 5.4). RESULTS In all, 43 studies, including 23,076 patients, were analyzed, of which 13,922 patients were treated with PBD and 9154 were treated with no preoperative biliary drainage (NPBD). The morbidity , infection morbidity , and postoperative pancreatic fistulae (POPF) in patients undergoing PBD, were significantly higher than those in patients undergoing NPBD. Further, PBD may lead to a significantly worse 2- and 3-year overall survival (OS) rates . In subgroup meta-analysis, the differences in morbidity, POPF, and OS outcomes lost significance between the PBD and NPBD groups when the mean total serum bilirubin (TSB) concentration was below 15 mg/dl. CONCLUSIONS Routine PBD still cannot be recommended because it showed no beneficial effect on postoperative outcomes. However, in patients with < 15 mg/dl TSB concentration, PBD tends to be a better choice.
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Affiliation(s)
- Shiyi Gong
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, Gansu, China.,Ningxia Medical University, Yinchuan, Ningxia, China.,Institution of Clinical Research and Evidence-Based Medicine, the Gansu Provincial Hospital, Lanzhou, Gansu, China.,Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
| | - Shaoming Song
- Institution of Clinical Research and Evidence-Based Medicine, the Gansu Provincial Hospital, Lanzhou, Gansu, China.,Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China.,Department of Clinical Medicine, The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu, China
| | - Qinghao Cheng
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, Gansu, China.,Ningxia Medical University, Yinchuan, Ningxia, China.,Institution of Clinical Research and Evidence-Based Medicine, the Gansu Provincial Hospital, Lanzhou, Gansu, China.,Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
| | - Yunxia Huang
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, Gansu, China.,Ningxia Medical University, Yinchuan, Ningxia, China
| | - Hongwei Tian
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Wutang Jing
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Caining Lei
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, Gansu, China.,Institution of Clinical Research and Evidence-Based Medicine, the Gansu Provincial Hospital, Lanzhou, Gansu, China.,Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
| | - Wenwen Yang
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, Gansu, China.,Institution of Clinical Research and Evidence-Based Medicine, the Gansu Provincial Hospital, Lanzhou, Gansu, China.,Department of Clinical Medicine, The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu, China
| | - Kehu Yang
- Institution of Clinical Research and Evidence-Based Medicine, the Gansu Provincial Hospital, Lanzhou, Gansu, China.,Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China.,Department of Clinical Medicine, The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu, China.,Key Laboratory of Evidence-Based Medicine Knowledge Translation of Gansu Province, Lanzhou, Gansu, China
| | - Tiankang Guo
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou, Gansu, China.,Ningxia Medical University, Yinchuan, Ningxia, China.,Institution of Clinical Research and Evidence-Based Medicine, the Gansu Provincial Hospital, Lanzhou, Gansu, China.,Department of Clinical Medicine, The First Clinical Medical College of Lanzhou University, Lanzhou, Gansu, China
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5
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Gong L, Huang X, Wang L, Xiang C. The effect of preoperative biliary stents on outcomes after pancreaticoduodenectomy: A meta-analysis. Medicine (Baltimore) 2020; 99:e22714. [PMID: 33080724 PMCID: PMC7571999 DOI: 10.1097/md.0000000000022714] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Whether biliary drainage should be performed before surgery in jaundiced patients is a topic of debate. Published studies on the effect of preoperative biliary drainage show great discrepancies in their conclusions, and the use of different drainage methods is an important factor. The aim of the present study was to investigate the effect of preoperative biliary stents (PBS) on postoperative outcomes in patients following pancreaticoduodenectomy (PD). METHODS MEDLINE, EMBASE, Science Citation Index Expanded, and the Cochrane database were searched up to October 2019 to identify all published articles related to the topic. A meta-analysis was performed to compare postoperative outcomes in patients with and without PBS. Quality assessment and data extraction from included studies were performed by 2 independent authors. Statistical analysis was performed using RevMan 5.2 software. RESULTS Twenty-seven studies involving 10,445 patients were included in the analysis. Biliary drainage was performed in 5769 patients (PBS group), and the remaining 4676 patients underwent PD directly (direct surgery [DS] group). Overall mortality, severe complications, abdominal hemorrhage, bile leakage, intra-abdominal abscess, and pancreatic fistula were not significantly different between the PBS and DS groups. However, overall morbidity, delayed gastric emptying, and wound infection were significantly higher in the PBS group compared to the DS group. Subgroup analysis indicated that the adverse effect of PBS on postoperative complications was more evident with increased stent proportion. CONCLUSIONS Preoperative biliary stenting increases overall morbidity, delayed gastric emptying, and wound infection rates in patients following PD. Thus, preoperative biliary drainage via stent placement should be avoided in patients waiting for PD.
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Guerrini GP, Soliani P, D'Amico G, Di Benedetto F, Negri M, Piccoli M, Ruffo G, Orti-Rodriguez RJ, Pissanou T, Fusai G. Pancreaticojejunostomy Versus Pancreaticogastrostomy After Pancreaticoduodenectomy: An Up-to-date Meta-Analysis. J INVEST SURG 2015; 29:175-84. [PMID: 26682701 DOI: 10.3109/08941939.2015.1093047] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The reconstruction of the pancreas after pancreaticoduodenectomy (PD) is a crucial factor in preventing postoperative complications as pancreatic anastomosis failure is associated with a high morbidity rate and contributes to prolonged hospitalization and mortality. Several techniques have been described for the reconstruction of pancreatic digestive continuity in the attempt to minimize the risk of a pancreatic fistula. The aim of this study was to compare the results of pancreaticogastrostomy and pancreaticojejunostomy after PD. METHODS A systematic review and meta-analysis were conducted of randomized controlled trials (RCTs) published up to January 2015 comparing patients with pancreaticogastrostomy (PG group) versus pancreaticojejunostomy (PJ group). Two reviewers independently assessed the eligibility and quality of the studies. The meta-analysis was conducted using either the fixed-effect or the random-effect model. RESULTS Eight RCTs describing 1,211 patients were identified for inclusion in the study. The meta-analysis shows that the PG group had a significantly lower incidence rate of postoperative pancreatic fistulas [OR 0.64 (95% confidence interval 0.46-0.86), p = .003], intra-abdominal abscesses [OR 0.53 (95% CI, 0.33-0.85), p = .009] and length of hospital stay [MD -1.62; (95% CI 2.63-0.61), p = .002] than the PJ group, while biliary fistula, mortality, morbidity, rate of delayed gastric emptying, reoperation, and bleeding did not differ between the two groups. CONCLUSION This meta-analysis suggests that the most effective treatment for reconstruction of pancreatic continuity after pancreatoduodenectomy is pancreaticogastrostomy. However, the advantage of the latter could potentially be demonstrated through further RCTs, including only patients at high risk of developing pancreatic fistulas.
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Affiliation(s)
- Gian Piero Guerrini
- a Ravenna Hospital, AUSL Romagna , HBP and General Surgery Unit , Ravenna , Italy
| | - Paolo Soliani
- a Ravenna Hospital, AUSL Romagna , HBP and General Surgery Unit , Ravenna , Italy
| | - Giuseppe D'Amico
- b Papa Giovanni XXIII Hospital and Milan University , Department of Surgery and Transplantation , Bergamo , Italy
| | - Fabrizio Di Benedetto
- c Policlinico Hospital, HPB and Liver Transplant Unit , University of Modena and Reggio Emilia , Modena , Italy
| | - Marco Negri
- a Ravenna Hospital, AUSL Romagna , HBP and General Surgery Unit , Ravenna , Italy
| | - Micaela Piccoli
- d Civile S. Agostino Estense Hospital , AUSL Modena, Robotic and General Surgery Unit , Modena , Italy
| | - Giacomo Ruffo
- e "Sacro Cuore-Don Calabria" Hospital , General Surgery Unit , Negrar (Verona) , Italy
| | - Rafael Jose Orti-Rodriguez
- f Royal Free Hospital, HPB & Liver Transplant Unit , University College Medical School of London , London , England
| | - Theodora Pissanou
- f Royal Free Hospital, HPB & Liver Transplant Unit , University College Medical School of London , London , England
| | - Giuseppe Fusai
- f Royal Free Hospital, HPB & Liver Transplant Unit , University College Medical School of London , London , England
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7
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Abstract
Preoperative biliary drainage (PBD) has been thought to be preferable regardless of the site of biliary strictures, e.g., distal or proximal strictures because PBD by endoscopy or interventional radiology decreases postoperative mortality and morbidity rates. However, recently, several studies have revealed that PBD strategy showed an increased mortality rate or a high frequency of surgical site infection. Herein, we reviewed reports in the literature regarding the current status of PBD and investigated the effects of PBD on patients with distal and proximal biliary obstructions due to potentially resectable pancreatobiliary cancers. Our summary demonstrated that there is as yet no optimal PBD method regardless of the distal and proximal biliary strictures because of the small sample size and the lack of better control groups in previous studies. Thus, prospective randomized studies with a large sample size are needed to establish the optimal mode of PBD and to evaluate the potential benefits of PBD in patients with both distal and proximal biliary obstructions.
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8
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Gurusamy K, Toon C, Virendrakumar B, Morris S, Davidson B. Feasibility of Comparing the Results of Pancreatic Resections between Surgeons: A Systematic Review and Meta-Analysis of Pancreatic Resections. HPB SURGERY : A WORLD JOURNAL OF HEPATIC, PANCREATIC AND BILIARY SURGERY 2015; 2015:896875. [PMID: 26351405 PMCID: PMC4553327 DOI: 10.1155/2015/896875] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 07/15/2015] [Indexed: 02/06/2023]
Abstract
Background. Indicators of operative outcomes could be used to identify underperforming surgeons for support and training. The feasibility of identifying HPB surgeons with poor operative performance ("outliers") based on the results of pancreatic resections is not known. Methods. A systematic review of Medline, Embase, and the Cochrane library was performed to identify studies on pancreatic resection including at least 100 patients and published between 2004 and 2014. Proportions that lay outside the upper 95% and 99.8% confidence intervals based on results of the systematic reviews were considered as "outliers." Results. In total, 30 studies reporting on 10712 patients were eligible for inclusion in this review. The average short-term mortality after pancreatic resections was 3.1% and proportion of patients with procedure-related complications was 47.0%. None of the classification systems assessed the long-term impact of the complications on patients. The surgeon-specific mortality should be 5 times the average mortality before he or she can be identified as an outlier with 0.1% false positive rate if he or she performs 50 surgeries a year. Conclusions. A valid risk prognostic model and a classification system of surgical complications are necessary before meaningful comparisons of the operative performance between pancreatic surgeons can be made.
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Affiliation(s)
- Kurinchi Gurusamy
- Department of Surgery, UCL Medical School, Royal Free Campus, London NW3 2PF, UK
| | - Clare Toon
- Public Health Research Unit, West Sussex County Council, County Hall Campus, West Sussex PO19 1QT, UK
| | - Bhavisha Virendrakumar
- Evidence Synthesis, Sightsavers, 35 Perrymount Road, Haywards Heath, West Sussex RH16 3BW, UK
| | - Steve Morris
- Department of Applied Health Research, UCL, London WC1E 7HB, UK
| | - Brian Davidson
- Department of Surgery, UCL Medical School, Royal Free Campus, London NW3 2PF, UK
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Chen Y, Ou G, Lian G, Luo H, Huang K, Huang Y. Effect of Preoperative Biliary Drainage on Complications Following Pancreatoduodenectomy: A Meta-Analysis. Medicine (Baltimore) 2015; 94:e1199. [PMID: 26200634 PMCID: PMC4603006 DOI: 10.1097/md.0000000000001199] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Preoperative biliary drainage (PBD) prior to pancreatoduodenectomy (PD) is still controversial; therefore, the aim of this study was to examine the impact of PBD on complications following PD. A meta-analysis was carried out for all relevant randomized controlled trials (RCTs), prospective and retrospective studies published from inception to March 2015 that compared PBD and non-PBD (immediate surgery) for the development of postoperative complications in PD patients. Pooled odds ratio (OR) and 95% confidence interval (CI) were estimated using fixed-effect analyses, or random-effects analyses if there was statistically significant heterogeneity (P < 0.05). Eight RCTs, 13 prospective studies, 20 retrospective studies, and 3 Chinese local retrospective studies with 6286 patients were included in this study. In a pooled analysis, there were no significant differences between PBD and non-PBD group in the risks of mortality, morbidity, intra-abdominal abscess, sepsis, hemorrhage, pancreatic leakage, and biliary leakage. However, subgroup analysis of RCTs yielded a trend toward reduced risk of morbidity in PBD group (OR 0.48, CI 0.24 to 0.97; P = 0.04). Compared with non-PBD, PBD was associated with significant increase in the risk of infectious complication (OR 1.52, CI 1.07 to 2.17; P = 0.02), wound infection (OR 2.09, CI 1.39 to 3.13; P = 0.0004), and delayed gastric emptying (DGE) (OR 1.37, CI 1.08 to 1.73; P = 0.009). This meta-analysis suggests that biliary drainage before PD increased postoperative infectious complication, wound infection, and DGE. In light of the results of the study, PBD probably should not be routinely carried out in PD patients.
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Affiliation(s)
- Yinting Chen
- From the Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation (YC, GL, KH); Department of Gastroenterology (YC, GL, KH), Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; Department of Gastrointestinal Surgery (GO, YH), The Third Affiliated Hospital of Sun Yat-Sen University; and Department of Anesthesiology (HL), The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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Petera J, Dušek L, Sirák I, Soumarova R, Jarkovsky J. Cancer in the elderly in the Czech Republic. Eur J Cancer Care (Engl) 2015; 24:163-78. [DOI: 10.1111/ecc.12287] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2014] [Indexed: 12/26/2022]
Affiliation(s)
- J. Petera
- Department of Oncology and Radiotherapy; University Hospital and Medical Faculty; Hradec Kralove Czech Republic
| | - L. Dušek
- Institute of Biostatistics and Analyses; Masaryk University; Brno Czech Republic
| | - I. Sirák
- Department of Oncology and Radiotherapy; University Hospital; Hradec Kralove Czech Republic
| | - R. Soumarova
- Department of Radiotherapy and Oncology; Mendel Cancer Centre; Nový Jičín Czech Republic
| | - J. Jarkovsky
- Institute of Biostatistics and Analyses; Masaryk University; Brno Czech Republic
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Chen Z, Song X, Yang D, Li Y, Xu K, He Y. Pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy: A meta-analysis of randomized control trials. Eur J Surg Oncol 2014; 40:1177-85. [DOI: 10.1016/j.ejso.2014.06.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 06/03/2014] [Accepted: 06/26/2014] [Indexed: 02/08/2023] Open
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12
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Mantas D, Charalampoudis P. Preoperative biliary drainage in patients with distal obstruction due to pancreatic head cancer. INTERNATIONAL JOURNAL OF ENDOCRINE ONCOLOGY 2014. [DOI: 10.2217/ije.13.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A total of 77% of pancreatic head cancers manifest with obstructive jaundice. Hyperbilirubinemia impairs immunity and nutrition and is responsible for systemic toxicity. Several studies have attempted to investigate the impact of biliary drainage prior to duodenopancreatectomy (preoperative biliary drainage [PBD]) on jaundice resolution, morbidity, mortality and infectious complications, conferring high controversy. One large randomized controlled trial concluded that PBD should not be recommended in patients with distal obstructive jaundice owing to high infection rates. However, this work has been extensively criticized due to the exclusion of severely jaundiced patients, lack of information regarding antimicrobial agents used and employment of plastic instead of metal stents. However, proponents of PBD favor its application in selected cases. This work aims to review the literature on PBD for jaundice due to pancreatic head malignancy, to outline the controversy pertaining to this modality and to identify the indications of PBD in selected patients with malignant distal obstruction.
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Affiliation(s)
- Dimitrios Mantas
- Second Department of Propedeutic Surgery, Laiko General Hospital, Athens University Medical School, 17 Agiou Thoma Street 11527, Athens, Greece
| | - Petros Charalampoudis
- Second Department of Propedeutic Surgery, Laiko General Hospital, Athens University Medical School, 17 Agiou Thoma Street 11527, Athens, Greece
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13
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Pancreatico-duodenectomy and postoperative pancreatic fistula: risk factors and technical considerations in a specialized HPB center. Updates Surg 2014; 66:145-50. [DOI: 10.1007/s13304-014-0253-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 04/05/2014] [Indexed: 12/19/2022]
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14
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Pancreaticoduodenectomy: Outcomes in a Low-Volume, Specialised Hepato Pancreato Biliary Unit. World J Surg 2013; 38:1484-90. [DOI: 10.1007/s00268-013-2431-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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15
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Conaglen PJ, Collier NA. Augmenting pancreatic anastomosis during whipple operation with fibrin glue: a beneficial technical modification? ANZ J Surg 2013; 84:266-9. [DOI: 10.1111/ans.12072] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2012] [Indexed: 12/29/2022]
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16
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Ngu W, Jones M, Neal CP, Dennison AR, Metcalfe MS, Garcea G. Preoperative biliary drainage for distal biliary obstruction and post-operative infectious complications. ANZ J Surg 2012; 83:280-6. [PMID: 23043467 DOI: 10.1111/j.1445-2197.2012.06296.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2012] [Indexed: 12/17/2022]
Abstract
BACKGROUND Preoperative biliary drainage (PBD) for distal bile duct obstruction may increase post-operative complications. This study examined the effect of PBD on positive bile culture (PBC) rates and complications after biliary bypass or pancreaticoduodenectomy. Bilirubin levels in the non-PBD cohort were also analysed to determine the impact on outcome. METHODS A retrospective case-note analysis from 2005 to the present day was undertaken. Statistical analysis was undertaken using Students's t-test, chi-squared test, receiver operator characteristics, correlation coefficient and relative risk ratios. RESULTS A total of 422 patients were identified undergoing pancreaticoduodenectomy or biliary bypass for either benign or malignant distal biliary obstruction. One hundred ninety-six patients had complete data regarding PBD and bile cultures. PBD resulted in a significantly higher relative risk of both infectious complications and positive bile cultures. Overall complication rate was greater in patients undergoing PBD. The major complication rate was equivalent between the two groups. Bilirubin levels in the non-PBD cohort did not correlate or predict length of stay, high-dependency stay, and mortality or complication rate. CONCLUSION There seems to be little value in PBD for patients with distal biliary obstruction other than to defer definitive surgery to a non-emergency setting. For most hepato-pancreato-biliary units, avoidance of PBD will prove logistically difficult.
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Affiliation(s)
- Wee Ngu
- Department of Hepatobiliary and Pancreatic Surgery, University Hospitals of Leicester, Leicester, UK
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Wo JY, Hong TS, Kachnic LA. Impact of Age and Comorbidities on the Treatment of Gastrointestinal Malignancies. Semin Radiat Oncol 2012; 22:311-20. [DOI: 10.1016/j.semradonc.2012.05.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Barbas AS, Turley RS, Ceppa EP, Reddy SK, Blazer DG, Clary BM, Pappas TN, Tyler DS, White RR, Lagoo SA. Comparison of outcomes and the use of multimodality therapy in young and elderly people undergoing surgical resection of pancreatic cancer. J Am Geriatr Soc 2011; 60:344-50. [PMID: 22211710 DOI: 10.1111/j.1532-5415.2011.03785.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To compare outcomes and the use of multimodality therapy in young and elderly people with pancreatic cancer undergoing surgical resection. DESIGN Retrospective, single-institution study. SETTING National Cancer Institute/National Comprehensive Cancer Network cancer center. PARTICIPANTS Two hundred three individuals who underwent pancreaticoduodenectomy for pancreatic adenocarcinoma at Duke University Medical Center comprised the study population. Participants were divided into three groups based on age (<65, n = 97; 65-74, n = 74; ≥75, N = 32). MEASUREMENTS Perioperative outcomes, the use of multimodality therapy, and overall survival of the different age groups were compared. RESULTS Similar rates of perioperative mortality and morbidity were observed in all age groups, but elderly adults were more likely to be discharged to a rehabilitation or skilled nursing facility. A similar proportion of participants received neoadjuvant therapy, but a smaller proportion of elderly participants received adjuvant therapy. Overall survival was similar between the age groups. Predictors of poorer overall survival included coronary artery disease, positive resection margin, and less-differentiated tumor histology. Treatment with neoadjuvant and adjuvant therapy were predictors of better overall survival. CONCLUSION Carefully selected elderly individuals experience similar perioperative outcomes and overall survival to those of younger individuals after resection of pancreatic cancer. There appears to be a significant disparity in the use of adjuvant therapy between young and elderly individuals.
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Affiliation(s)
- Andrew S Barbas
- Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
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Preoperative biliary stents in pancreatic cancer. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2011; 18:621-9. [PMID: 21667055 DOI: 10.1007/s00534-011-0403-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Pancreatic cancer is a common digestive cancer with high mortality, and surgical resection is the only potential curative treatment option. Pancreatic head cancer is usually accompanied by biliary obstruction, which potentially increases surgical complications following pancreaticoduodenectomy. Thus, preoperative biliary drainage has long been advocated. METHODS A review of the literature using Medline, Embase and Cochrane databases was undertaken. RESULTS Endoscopic or percutaneous biliary stent placement is technically successful in most patients. The use of routine preoperative biliary drainage in the setting of pancreatic cancer with biliary obstruction is controversial. Prospective studies have shown that complications related to preoperative biliary drainage using endoscopic placement of traditional plastic endoprostheses increase the overall morbidity compared to pancreaticoduodenectomy alone. Placement of self-expandable metal stents could reduce stent-related complication rates such as early occlusion because of prolonged patency, especially when surgery is delayed. CONCLUSION Pancreatic cancer patients with deep jaundice and expected delay prior to curative intent surgery are potential candidates for temporary biliary drainage. Cholangitis remains a formal indication for early, urgent preoperative biliary decompression for patients with pancreatic cancer.
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Qiu YD, Bai JL, Xu FG, Ding YT. Effect of preoperative biliary drainage on malignant obstructive jaundice: A meta-analysis. World J Gastroenterol 2011; 17:391-6. [PMID: 21253401 PMCID: PMC3022302 DOI: 10.3748/wjg.v17.i3.391] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Revised: 09/27/2010] [Accepted: 10/04/2010] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the effect of preoperative biliary drainage (PBD) on obstructive jaundice resulting from malignant tumors.
METHODS: According to the requirements of Cochrane systematic review, studies in the English language were retrieved from MEDLINE and Embase databases from 1995 to 2009 with the key word “preoperative biliary drainage”. Two reviewers independently screened the eligible studies, evaluated their academic level and extracted the data from the eligible studies confirmed by cross-checking. Data about patients with and without PBD after resection of malignant tumors were processed for meta-analysis using the Stata 9.2 software, including postoperative mortality, incidence of postoperative pancreatic and bile leakage, abdominal abscess, delayed gastric emptying and incision infection.
RESULTS: Fourteen retrospective cohort studies involving 1826 patients with malignant obstructive jaundice accorded with our inclusion criteria, and were included in meta-analysis. Their baseline characteristics were comparable in all the studies. No significant difference was found in combined risk ratio (RR) of postoperative mortality and incidence of pancreatic and bile leakage, abdominal abscess, delayed gastric emptying between patients with and without PBD. However, the combined RR for the incidence of postoperative incision infection was improved better in patients with PBD than in those without PBD (P < 0.05).
CONCLUSION: PBD cannot significantly reduce the postoperative mortality and complications of malignant obstructive jaundice, and therefore should not be used as a preoperative routine procedure for malignant obstructive jaundice.
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Lakhey PJ, Bhandari RS, Ghimire B, Khakurel M. Perioperative Outcomes of Pancreaticoduodenectomy: Nepalese Experience. World J Surg 2010; 34:1916-21. [DOI: 10.1007/s00268-010-0589-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Augenstein VA, Reuter NP, Bower MR, McMasters KM, Scoggins CR, Martin RC. Bile cultures: A guide to infectious complications after pancreaticoduodenectomy. J Surg Oncol 2010; 102:478-81. [DOI: 10.1002/jso.21612] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Abstract
OBJECTIVES No conclusive evidence exists confirming the role of preoperative biliary drainage (PBD) in reversing the physiological disturbances resulting from biliary obstruction to improve outcome. This review examined the impact of PBD and the outcomes after surgery. METHODS A PubMed literature search was undertaken using the keywords preoperative, biliary, and drainage. The primary end points were the effect of PBD on mortality, morbidity, and bile cultures. The secondary outcome measures were PBD and pancreatic leakage, intra-abdominal abscess, sepsis/infectious complications, wound infection, hemorrhage, and bile leak rates. The impact of bile cultures positive for bacteria and the outcomes after surgery were also examined. RESULTS Preoperative biliary drainage significantly increases wound and bile infection rates on meta-analysis (P < 0.0005) using a fixed and random effect model, but no adverse effect on mortality and morbidity was found. A bile culture positive for bacteria negatively impacts on both mortality and morbidity (P < 0.005) after surgery. CONCLUSIONS Preoperative biliary drainage significantly increases the rates of bile culture positive for bacteria and the probability of wound infection. Bile cultures positive for bacteria adversely impact mortality and morbidity after surgery in jaundiced patients. Although no evidence has been found by this review that PBD directly increases mortality and morbidity, it is possible that in certain patients, PBD may deleteriously affect outcome by bacterial contamination of the bile.
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Su Z, Koga R, Saiura A, Natori T, Yamaguchi T, Yamamoto J. Factors influencing infectious complications after pancreatoduodenectomy. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2009; 17:174-9. [PMID: 19517055 DOI: 10.1007/s00534-009-0128-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2008] [Accepted: 05/18/2009] [Indexed: 02/06/2023]
Abstract
BACKGROUND/PURPOSE Rates of postoperative morbidity, particularly infectious complications, remain high after pancreatoduodenectomy. METHODS Subjects comprised 101 patients who had undergone pancreatoduodenectomy, analyzed according to presence or absence of infectious postoperative complications. Nineteen perioperative variables were analyzed to identify risk factors associated with postoperative infectious complications. RESULTS Postoperative infectious complications occurred in 56 patients (55%); among them 29 had serious infectious morbidity, including bacteremia (13%), intra-abdominal infection (18%) and pneumonia (12%). One patient (1%) died of multiple organ failure subsequent to a severe septic attack. Only body mass index (BMI) differed significantly between patients with and without serious infection. Logistic regression analysis identified BMI >25 as an independent factor for occurrence of serious postoperative infectious complications. BMI >25 was a common risk factor for individual infection, including bacteremia, intra-abdominal infection, and pneumonia. As for the influence of BMI on perioperative parameters, the high BMI significantly affected the operation time. Meanwhile preoperative biliary drainage had no influence on overall and individual infectious morbidities. CONCLUSIONS This study demonstrates the need for careful postoperative monitoring in the patient with high BMI.
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Affiliation(s)
- Zhongxue Su
- Department of Surgery, Shandong Provincial Hospital, Shandong, China
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Quality of Life of Patients Following Pylorus-Sparing Pancreatoduodenectomy. POLISH JOURNAL OF SURGERY 2008. [DOI: 10.2478/v10035-008-0047-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Fang WL, Shyr YM, Su CH, Chen TH, Wu CW, Lui WY. Comparison between pancreaticojejunostomy and pancreaticogastrostomy after pancreaticoduodenectomy. J Formos Med Assoc 2007; 106:717-27. [PMID: 17908661 DOI: 10.1016/s0929-6646(08)60033-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND/PURPOSE Pancreatic leakage is a leading cause of morbidity and mortality after pancreaticoduodenectomy (PD). Pancreaticogastrostomy (PG) has been reported to be associated with a lower pancreatic leakage rate and morbidity rate than pancreaticojejunostomy (PJ). This study compared the preoperative characteristics, surgical risk factors, intraoperative parameters, and postoperative outcome between PJ and PG. METHODS From March 1992 to March 2005, a comparative study between PJ and PG for patients with periampullary lesions undergoing PD was conducted. A total of 377 consecutive patients underwent PD. Among them, 188 patients underwent PJ and 189 underwent PG. RESULTS The overall mortality, morbidity and pancreatic leakage following PD were 5%, 45.1% and 10.6%, respectively. The mortality, morbidity and pancreatic leakage were 8.9%, 56.4% and 17.6% in the PJ group, and 2.1%, 33.9% and 3.7% in the PG group (p < 0.001). Mean operative time was 9.3 hours versus 6.7 hours (p < 0.001), mean blood loss was 1032 mL versus 891 mL (p = 0.064) and mean hospital stay was 34.8 days versus 26.1 days (p < 0.001) in the PJ and PG groups, respectively. PJ, soft pancreas, pancreatic duct stenting, low surgical volume (< 20) and age (> 65 years) were identified as risk factors for pancreatic leakage, while PJ, soft pancreas, pancreatic duct stenting and low surgical volume (< 20) were four significant risk factors for surgical morbidity. Further, PJ, pancreatic leakage, low surgical volume (< 20) and age (> 65 years) were identified to be surgical risk factors for mortality. CONCLUSION PG is a safer method than PJ following PD as a significantly lower rate of pancreatic leakage, surgical morbidity and mortality, shorter operation time, and shorter postoperative hospital stay are reported.
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Affiliation(s)
- Wen-Liang Fang
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
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Bhati CS, Kubal C, Sihag PK, Gupta AA, Jenav RK, Inston NG, Mehta JM. Effect of preoperative biliary drainage on outcome of classical pancreaticoduodenectomy. World J Gastroenterol 2007; 13:1240-2. [PMID: 17451206 PMCID: PMC4147000 DOI: 10.3748/wjg.v13.i8.1240] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the role of preoperative biliary drainage (PBD) in the outcome of classical pancreaticoduodenectomy.
METHODS: A 10-year retrospective data analysis was performed on patients (n = 48) undergoing pancreaticoduodenectomy from March 1994 to March 2004 in department of surgery at SMS medical college, Jaipur, India. Demographic variables, details of preoperative stenting, operative procedure and post operative complications were noted.
RESULTS: Preoperative biliary drainage was performed in 21 patients (43.5%). The incidence of septic complications was significantly higher in patients with biliary stent placement (P < 0.05, 0 vs 4). This group of patients also had a significantly higher minor biliary leak rate. Mortality and hospital stay in each group was comparable.
CONCLUSION: Within this study population the use of PBD by endoscopic stenting was associated with a high incidence of infective complications. These findings do not support the routine use of biliary stenting in patients prior to pancreatico-duodenectomy.
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