Significance of bile culture surveillance for postoperative management of pancreatoduodenectomy

World Journal of Surgical Oncology - Tập 17 Số 1 - 2019
Keizō Sugimachi1, Tomohiro Iguchi1, Yohei Mano1, Masaru Morita2, Masaki Mori3, Yasushi Toh2
1Department of Hepatobiliary-Pancreatic Surgery, National Hospital Organization Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, Fukuoka, 811-1395, Japan
2Department of Gastroenterological Surgery, National Hospital Organization Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, Fukuoka, 811-1395, Japan
3Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

Tóm tắt

Abstract Background The management of infectious complications is important in pancreatoduodenectomy (PD). We sought to determine the significance of preoperative surveillance bile culture in perioperative management of PD. Methods This study enrolled 69 patients who underwent PD for malignant tumors at a single institute between 2014 and 2017. Surveillance bile culture was performed before or during surgery. Correlations between the incidence of infectious postoperative complications and clinicopathological parameters, including bile cultures, were evaluated. Results Preoperative positive bile culture was confirmed in 28 of 51 patients (55%). Bile culture was positive in 27 of 30 cases (90%) with preoperative biliary drainage, and 1 of 21 cases (5%) without drainage (p < 0.01). Preoperative isolated microorganisms in bile were consistent with those detected in surgical sites in 11 of 27 cases (41%). Cases with positive multi-drug-resistant bacteria in preoperative bile culture showed significantly higher incisional SSI after PD (p = 0.01). The risk factors for the incidence of organ/space SSI were soft pancreatic texture (p = 0.01) and smoking history (p = 0.02) by multivariate analysis. Preoperative positive bile culture was neither associated with organ/space SSI nor overall postoperative complications. Conclusions Preoperative surveillance bile culture is useful for the management of wound infection, prediction of causative pathogens for infectious complications, and the selection of perioperative antibiotic prophylaxis.

Từ khóa


Tài liệu tham khảo

Greenblatt DY, Kelly KJ, Rajamanickam V, Wan Y, Hanson T, Rettammel R, Winslow ER, Cho CS, Weber SM. Preoperative factors predict perioperative morbidity and mortality after pancreaticoduodenectomy. Ann Surg Oncol. 2011;18:2126–35.

Gouma DJ, van Geenen RC, van Gulik TM, de Haan RJ, de Wit LT, Busch OR, Obertop H. Rates of complications and death after pancreaticoduodenectomy: risk factors and the impact of hospital volume. Ann Surg. 2000;232:786–95.

Shrikhande SV, Sivasanker M, Vollmer CM, Friess H, Besselink MG, Fingerhut A, Yeo CJ, Fernandez-delCastillo C, Dervenis C, Halloran C, et al. Pancreatic anastomosis after pancreatoduodenectomy: a position statement by the International Study Group of Pancreatic Surgery (ISGPS). Surgery. 2017;161:1221–34.

Sugimachi K, Iguchi T, Mano Y, Nishijima T, Nakanoko T, Uehara H, Sugiyama M, Ohta M, Ikebe M, Morita M, et al. The impact of immunonutritional and physical status on surgical outcome after pancreaticoduodenectomy in elderly Patients. Anticancer Res. 2019;39:6347–53.

Sauvanet A, Boher JM, Paye F, Bachellier P, Sa Cuhna A, Le Treut YP, Adham M, Mabrut JY, Chiche L, Delpero JR, French Association of S. Severe jaundice increases early severe morbidity and decreases long-term survival after pancreaticoduodenectomy for pancreatic adenocarcinoma. J Am Coll Surg. 2015;221:380–9.

Lee PJ, Podugu A, Wu D, Lee AC, Stevens T, Windsor JA. Preoperative biliary drainage in resectable pancreatic cancer: a systematic review and network meta-analysis. HPB (Oxford). 2018;20:477–86.

Mussle B, Hempel S, Kahlert C, Distler M, Weitz J, Welsch T. Prognostic impact of bacterobilia on morbidity and postoperative management after pancreatoduodenectomy: a systematic review and meta-analysis. World J Surg. 2018;42:2951–62.

Ohgi K, Sugiura T, Yamamoto Y, Okamura Y, Ito T, Uesaka K. Bacterobilia may trigger the development and severity of pancreatic fistula after pancreatoduodenectomy. Surgery. 2016;160:725–30.

Cortes A, Sauvanet A, Bert F, Janny S, Sockeel P, Kianmanesh R, Ponsot P, Ruszniewski P, Belghiti J. Effect of bile contamination on immediate outcomes after pancreaticoduodenectomy for tumor. J Am Coll Surg. 2006;202:93–9.

Sudo T, Murakami Y, Uemura K, Hayashidani Y, Hashimoto Y, Ohge H, Sueda T. Specific antibiotic prophylaxis based on bile cultures is required to prevent postoperative infectious complications in pancreatoduodenectomy patients who have undergone preoperative biliary drainage. World J Surg. 2007;31:2230–5.

Sugawara G, Yokoyama Y, Ebata T, Igami T, Yamaguchi J, Mizuno T, Yagi T, Nagino M. Preoperative biliary colonization/infection caused by multidrug-resistant (MDR) pathogens in patients undergoing major hepatectomy with extrahepatic bile duct resection. Surgery. 2018;163:1106–13.

Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, Harbarth S, Hindler JF, Kahlmeter G, Olsson-Liljequist B, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2012;18:268–81.

Sugawara G, Yokoyama Y, Ebata T, Mizuno T, Yagi T, Ando M, Nagino M. Duration of antimicrobial prophylaxis in patients undergoing major hepatectomy with extrahepatic bile duct resection: a randomized controlled trial. Ann Surg. 2018;267:142–8.

Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M. International Study Group on Pancreatic Fistula D: Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005;138:8–13.

Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.

Vollmer CM Jr, Sanchez N, Gondek S, McAuliffe J, Kent TS, Christein JD, Callery MP, Pancreatic Surgery Mortality Study G. A root-cause analysis of mortality following major pancreatectomy. J Gastrointest Surg. 2012;16:89–102 discussion 102-103.

De Pastena M, Paiella S, Marchegiani G, Malleo G, Ciprani D, Gasparini C, Secchettin E, Salvia R, Bassi C. Postoperative infections represent a major determinant of outcome after pancreaticoduodenectomy: results from a high-volume center. Surgery. 2017;162:792–801.

Callery MP, Pratt WB, Kent TS, Chaikof EL, Vollmer CM Jr. A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy. J Am Coll Surg. 2013;216:1–14.

Sugimoto M, Takahashi S, Kojima M, Kobayashi T, Gotohda N, Konishi M. In patients with a soft pancreas, a thick parenchyma, a small duct, and fatty infiltration are significant risks for pancreatic fistula after pancreaticoduodenectomy. J Gastrointest Surg. 2017;21:846–54.

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. 2013;83:280–6. https://doi.org/10.1111/j.1445-2197.2012.06296.x Epub 02012 Oct 06298.

Ng ZQ, Suthananthan AE, Rao S. Effect of preoperative biliary stenting on post-operative infectious complications in pancreaticoduodenectomy. Ann Hepatobiliary Pancreat Surg. 2017;21:212–6. https://doi.org/10.14701/ahbps.12017.14721.14704.14212 Epub 12017 Nov 14730.

Nagino M, Takada T, Miyazaki M, Miyakawa S, Tsukada K, Kondo S, Furuse J, Saito H, Tsuyuguchi T, Yoshikawa T, et al. Preoperative biliary drainage for biliary tract and ampullary carcinomas. J Hepatobiliary Pancreat Surg. 2008;15:25–30.

Yokoyama Y, Ebata T, Igami T, Sugawara G, Nagino M. Is the enteral replacement of externally drained pancreatic juice valuable after pancreatoduodenectomy? Surg Today. 2014;44:252–9.

Javed AA, Wright MJ, Siddique A, Blair AB, Ding D, Burkhart RA, Makary M, Cameron JL, Narang A, Herman J, et al. Outcome of patients with borderline resectable pancreatic cancer in the contemporary era of neoadjuvant chemotherapy. J Gastrointest Surg. 2018.

Okamura K, Tanaka K, Miura T, Nakanishi Y, Noji T, Nakamura T, Tsuchikawa T, Okamura K, Shichinohe T, Hirano S. Randomized controlled trial of perioperative antimicrobial therapy based on the results of preoperative bile cultures in patients undergoing biliary reconstruction. J Hepatobiliary Pancreat Sci. 2017;24:382–93.

Thông tin
Thông tin xuất bản

World Journal of Surgical Oncology

Tập 17 Số 1

Thông tin tác giả