New insight into the association between bile infection and clinically relevant pancreatic fistula in patients undergoing pancreatoduodenectomy

Nakamura, Kota; Sho, Masayuki; Kinoshita, Shoichi; Akahori, Toshikazu; Nagai, Minako; Nakagawa, Kenji; Takagi, Tadataka; Ikeda, Naoya

doi:10.1002/jhbp.781

Cited by 8 publications

(13 citation statements)

References 29 publications

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“…Seven studies [ 16 , 27 , 29 , 32 , 33 , 38 , 39 ] analyzed the relationship of pancreatic duct diameter <3 mm and CR-POPF, involving 12,325 patients. The fixed effects model was used for data synthesis because of a low heterogeneity ( I 2 = 28%) among the 7 studies.…”

Section: Resultsmentioning

confidence: 99%

“…The relationship of preoperative chemoradiotherapy and CR-POPF was assessed by 5 studies with 11,128 patients. [20,27,32,34,39] There was a low heterogeneity ( I 2 = 49%), so the fixed effects model was adopted. The pooled data showed that preoperative chemoradiotherapy was a significant protective factor of CR-POPF (OR = 0.68, 95% CI: 0.57–0.81, P < .001) (Fig.…”

Section: Resultsmentioning

confidence: 99%

“…The relationship of pathology type and CR-POPF was assessed by 10 studies with 14,487 patients. [13,21,27,28,[32][33][34][35]38,39] There was a low heterogeneity (I 2 = 33%), and the fixed effects model was used. The pooled data indicated that compared with other pathology types, pancreatic adenocarcinoma was a significant protective factor of CR-POPF (OR = 0.54, 95% CI: 0.47-0.61, P < .001) (Fig.…”

Section: Pathology Typementioning

confidence: 99%

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Risk factors of clinically relevant postoperative pancreatic fistula after pancreaticoduodenectomy: A systematic review and meta-analysis

Zhang

Yuan

et al. 2022

Medicine

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Background: Clinically relevant postoperative pancreatic fistula (CR-POPF) is a common and troublesome complication after pancreatoduodenectomy (PD). We conducted a systematic review and meta-analysis to identify the risk factors of CR-POPF after PD. Methods: We searched PubMed, EMBASE, and Cochrane Library databases for studies related to risk factors of CR-POPF after PD. Odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were extracted from the included studies, then a meta-analysis was conducted. If necessary, sensitivity analysis would be performed by changing the effect model or excluding 1 study at a time. Publication bias was assessed by funnel plot and Begg test and Egger test. Results: A total of 27 studies with 24,740 patients were included, and CR-POPF occurred in 3843 patients (incidence = 17%, 95% CI: 16%–19%). Male (OR = 1.56, 95% CI: 1.42–1.70), body mass index >25 kg/m 2 (OR = 1.98, 95% CI: 1.23–3.18), pancreatic duct diameter <3 mm (OR = 1.87, 95% CI: 1.66–2.12), soft pancreatic texture (OR = 3.49, 95% CI: 2.61–4.67), and blood transfusion (OR = 3.10, 95% CI: 2.01–4.77) can significantly increase the risk of CR-POPF. Pancreatic adenocarcinoma (OR = 0.54, 95% CI: 0.47–0.61), vascular resection (OR = 0.57, 95% CI: 0.39–0.83), and preoperative chemoradiotherapy (OR = 0.68, 95% CI: 0.57–0.81) can significantly decrease the factor of CR-POPF. Diabetes mellitus was not statistically associated with CR-POPF (OR = 0.66, 95% CI: 0.40–1.08). However, the analysis of body mass index, pancreatic texture, and diabetes mellitus had a high heterogeneity, then sensitivity analysis was performed, and the result after sensitivity analysis showed diabetes mellitus can significantly decrease the risk of CR-POPF. There was no significant publication bias in this meta-analysis. Conclusions: The current review assessed the effects of different factors on CR-POPF. This can provide a basis for the prevention and management of CR-POPF. Effective interventions targeting the above risk factors should be investigated in future studies for decreasing the occurrence of CR-POPF.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Pathology Typementioning

confidence: 99%

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Risk factors of clinically relevant postoperative pancreatic fistula after pancreaticoduodenectomy: A systematic review and meta-analysis

Zhang

Yuan

et al. 2022

Medicine

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“…The autodigestive effect of leaky pancreatic juice damages surrounding tissue and encourages infections (39). At the same time, infection can affect the healing of pancreaticointestinal anastomosis and further aggravate the severity of POPF (40). Therefore, in clinical practice, it is necessary to closely detect the bacteria in the drainage fluid when CR-POPF occurred.…”

Section: Discussionmentioning

confidence: 99%

Risk factors and microbial spectrum for infectious complications after pancreaticoduodenectomy

Fang¹,

Yang²,

Liang³

et al. 2021

Gland Surg

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Background: Although the mortality of pancreaticoduodenectomy (PD) has decreased, the morbidity especially infections is still a severe challenge. This study aimed to identify the risk factors and microbial spectrum for infectious complications after PD.Methods: This retrospective study of 291 consecutive patients who underwent PD between February 2018 and March 2021 was conducted. The clinical data was reviewed and risk factors associated with infectious complications were analyzed. To investigate the microbial spectrum, microorganisms isolated from preoperative bile, drainage fluid and blood were counted.Results: A total of 110 patients (37.8%) developed postoperative infections. The patients who suffered infections had higher severe complications, prolonged hospitalization and increased expenditures. Three independent risk factors were identified: preoperative biliary drainage (PBD) [odds ratio (OR) 2.082; 95% confidence interval (CI): 1.059-4.091; P=0.033], clinically relevant postoperative pancreatic fistula (CR-POPF) (OR 11.984; 95% CI: 6.556-21.471; P=0.000) and biliary fistula (BF) (OR 3.674; 95% CI: 1.218-11.084; P=0.021). K. pneumoniae and E. faecalis were the most frequently isolated bacteria in preoperative bile and drainage fluid after PD. K. pneumoniae and S. haemolyticus were the most common bacteria in bacteremia patients.Conclusions: PBD, POPF and BF are independent risk factors for infectious complications after PD. To lower the incidence of infection, PBD should be performed only in select cases and efforts should be taken to reduce the POPF and BF. The pathogens of bile and drainage fluid should be monitored throughout the hospital stay.

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“…[6][7][8][9][10] The presence of organ/space infections has also been shown to lead to clinically relevant postoperative pancreatic fistula. 11 Current Centre of Disease Control (CDC) guidelines recommend administration of a first-generation cephalosporin as perioperative antibiotic prophylaxis, 12 whereas the surgical care improvement project advocate the use of second-generation cephalosporin in hepatopancreatobiliary operations. 13 There is widespread heterogeneity regarding the choice of antibiotics amongst hepatopancreatobiliary surgeons worldwide.…”

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confidence: 99%

The Role of Targeted Versus Standard Antibiotic Prophylaxis in Pancreatoduodenectomy in Reducing Postoperative Infectious Complications

et al. 2021

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Introduction: Infectious complications are common after pancreatoduodenectomy, which in turn are associated with preoperative biliary drainage. Current guidelines recommend a first-generation cephalosporin as perioperative antibiotic prophylaxis. However, some studies support the use of targeted antibiotics. The aim of this systematic review and meta-analysis is to evaluate the role of prophylactic targeted antibiotics compared to standard antibiotics in reducing postoperative infections after pancreatoduodenectomy. Methods: A search from MEDLINE, EMBASE, and Cochrane library from 1946 to July 2020 was conducted. Studies were included if they compared targeted antibiotics with standard perioperative antibiotics while including outcome data on surgical site infections (SSI). Targeted therapy was defined as perioperative antibiotics targeting organisms prevalent in bile instrumentation or by culture data obtained from the patient or institution. Outcomes assessed were the rate of SSIs and their microbiology profile. Analyses included demographic data, perioperative antibiotics, postoperative outcomes including microbiology data, and meta-analysis was performed where applicable. Results: Seven studies were included, with a total of 849 patients undergoing pancreatoduodenectomy. Targeted antibiotics were associated with a significantly lower rate of postoperative SSI compared to standard antibiotic therapy [21.1% vs 41.9%; risk ratios (RR) 0.55, 95% confidence interval 0.37-0.81]. Wound/incisional site infections and organ space infections were lower in patients receiving targeted antibiotic prophylaxis (RR 0.33, P ¼ 0.0002 and RR 0.54, P ¼ 0.0004, respectively). Enterococcus species were the most common bacteria reported. Conclusion: There was a significant reduction in overall SSI rates when targeted antibiotics was used. Current standard antibiotic prophylaxis is inadequate in covering microbes prevalent in postoperative infections developing after pancreatoduodenectomy.

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New insight into the association between bile infection and clinically relevant pancreatic fistula in patients undergoing pancreatoduodenectomy

Cited by 8 publications

References 29 publications

Risk factors of clinically relevant postoperative pancreatic fistula after pancreaticoduodenectomy: A systematic review and meta-analysis

Risk factors of clinically relevant postoperative pancreatic fistula after pancreaticoduodenectomy: A systematic review and meta-analysis

Risk factors and microbial spectrum for infectious complications after pancreaticoduodenectomy

The Role of Targeted Versus Standard Antibiotic Prophylaxis in Pancreatoduodenectomy in Reducing Postoperative Infectious Complications

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