Endoscopic Retrograde Biliary Drainage Causes Intra-Abdominal Abscess in Pancreaticoduodenectomy Patients: An Important But Neglected Risk Factor
Journal
Annals of surgical oncology
Journal Volume
26
Journal Issue
4
Date Issued
2019-04
Author(s)
Abstract
Background: Patients with periampullary cancer frequently suffer obstructive jaundice and commonly require preoperative biliary drainage (PBD) for relief and to avoid related complications. Although research has established a correlation between PBD and surgical wound infection, the impact of PBD on major infectious complications (intra-abdominal abscess [IAA]) and overall mortality remains debatable. We hypothesized that PBD could lead to IAA and mortality, and evaluated their correlation in patients undergoing pancreaticoduodenectomy (PD).
Methods: We enrolled patients undergoing PD at an Asian academic medical center between 2007 and 2016. The types of PBD included endoscopic retrograde biliary drainage (ERBD) and percutaneous transhepatic cholangiography and drainage (PTCD). The primary outcome was IAA, defined as the presence of pus or infected fluid inside the abdominal cavity and with documented infectious pathogens.
Results: There was one (0.1%) 30-day mortality and eight (0.9%) 90-day mortalities among 899 consecutive patients examined. More than one-quarter of patients had PBD (n = 237, 26.4%; 165 ERBD, 72 PTCD). In the ERBD, PTCD, and non-PBD groups, the IAA rates were 37.0%, 16.7%, and 10.6%, respectively. On multivariate analysis, ERBD (odds ratio 3.67; 95% confidence interval 2.22-6.06; p < 0.001) was the only significant factor associated with IAA. No significant factor was found to analyze variables associated with mortality.
Conclusions: ERBD, but not PTCD, is associated with an increased risk of IAA in patients undergoing PD, which suggests that ERBD should be avoided whenever possible to prevent IAA. Further randomized clinical trials should be conducted to validate this relationship.
SDGs
Other Subjects
bilirubin; abdominal abscess; abdominal pain; aged; Article; biliary tract drainage; bilirubin blood level; cholangitis; controlled study; endoscopic retrograde biliary drainage; endoscopic surgery; female; heart infarction; human; intestine necrosis; intestine perforation; liver failure; major clinical study; male; pancreas fistula; pancreaticoduodenectomy; pancreatitis; percutaneous transhepatic cholangiography; postoperative hemorrhage; preoperative treatment; retrospective study; risk factor; septic shock; surgical mortality; abdominal abscess; bile duct tumor; endoscopic retrograde cholangiopancreatography; follow up; middle aged; pancreas carcinoma; pancreas tumor; pancreaticoduodenectomy; pathology; preoperative care; prognosis; prospective study; surgical infection; survival rate; Abdominal Abscess; Aged; Carcinoma, Pancreatic Ductal; Cholangiopancreatography, Endoscopic Retrograde; Common Bile Duct Neoplasms; Drainage; Female; Follow-Up Studies; Humans; Male; Middle Aged; Pancreatic Neoplasms; Pancreaticoduodenectomy; Preoperative Care; Prognosis; Prospective Studies; Retrospective Studies; Risk Factors; Surgical Wound Infection; Survival Rate
Type
journal article