Because the survival rate for patients experiencing late complications after pancreaticoduodenectomy (PD) is increasing, late complications should receive as much attention as early complications do.
Between April 2007 and August 2016, 133 patients underwent PD at our institution. We analyzed their cases to determine the predictors of late cholangitis after PD.
Of the 133 patients, 28 (21.1%) were diagnosed with postoperative cholangitis. A multivariate analysis showed that abnormal postoperative values of alkaline phosphatase were independently associated with postoperative cholangitis (odds ratio, 3.81; 95% confidence interval, 1.519–9.553; P = 0.004). The optimal cut-off value for postoperative alkaline phosphatase calculated from the receiver operating characteristic curve was 410 IU/L (sensitivity, 76.2%; specificity, 67.9%; area under the curve, 0.73). A univariate analysis to identify risk factors showed that pneumobilia was significantly related to a postoperative alkaline phosphatase value ≥ 410 IU/L (P = 0.041).
This study suggests that an alkaline phosphatase level ≥ 410 IU/L is a predictor of late postoperative cholangitis. In addition, pneumobilia is also related to the postoperative alkaline phosphatase level. Therefore, alkaline phosphatase levels should be carefully monitored in patients with postoperative pneumobilia in the late postoperative course.
Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Traverso LW, et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery. 2007;142:761–8. CrossRefPubMed
Yamaguchi K, Tanaka M, Chijiiwa K, Nagakawa T, Imamura M, Takada T. Early and late complications of pylorus-preserving pancreatoduodenectomy in Japan 1998. J Hepato-Biliary-Pancreat Surg. 1999;6:303–11. CrossRef
Imai H, Osada S, Tanahashi T, Sasaki Y, Tanaka Y, Okumura N, Matsuhashi N, Nonaka K, Nagase M, Takahashi T, et al. Retrospective evaluation of the clinical necessity of external biliary drainage after pancreaticoduodenectomy. Hepato-Gastroenterology. 2013;60:2119–24. PubMed
Malgras B, Duron S, Gaujoux S, Dokmak S, Aussilhou B, Rebours V, Palazzo M, Belghiti J, Sauvanet A. Early biliary complications following pancreaticoduodenectomy: prevalence and risk factors. HPB (Oxford). 2016;18:367–74. CrossRef
Fong ZV, Ferrone CR, Thayer SP, Wargo JA, Sahora K, Seefeld KJ, Warshaw AL, Lillemoe KD, Hutter MM, Fernandez-Del Castillo C. Understanding hospital readmissions after pancreaticoduodenectomy: can we prevent them?: a 10-year contemporary experience with 1,173 patients at the Massachusetts General Hospital. J Gastrointest Surg. 2014;18:137–44. discussion 144-135 CrossRefPubMed
Cammann S, Timrott K, Vonberg RP, Vondran FW, Schrem H, Suerbaum S, Klempnauer J, Bektas H, Kleine M. Cholangitis in the postoperative course after biliodigestive anastomosis. Langenbeck’s Arch Surg. 2016;401:715–24. CrossRef
Parra-Membrives P, Martinez-Baena D, Sanchez-Sanchez F. Late biliary complications after pancreaticoduodenectomy. Am Surg. 2016;82:456–61. PubMed
Pannala R, Brandabur JJ, Gan SI, Gluck M, Irani S, Patterson DJ, Ross AS, Dorer R, Traverso LW, Picozzi VJ, Kozarek RA. Afferent limb syndrome and delayed GI problems after pancreaticoduodenectomy for pancreatic cancer: single-center, 14-year experience. Gastrointest Endosc. 2011;74:295–302. CrossRefPubMed
Hashimoto N. Hepatobiliary imaging after pancreaticoduodenectomy—a comparative study on Billroth I and Billroth II reconstruction. Hepato-Gastroenterology. 2005;52:1023–5. PubMed
Sourrouille I, Gaujoux S, Lacave G, Bert F, Dokmak S, Belghiti J, Paugam-Burtz C, Sauvanet A. Five days of postoperative antimicrobial therapy decreases infectious complications following pancreaticoduodenectomy in patients at risk for bile contamination. HPB (Oxford). 2013;15:473–80. CrossRef
Sahora K, Morales-Oyarvide V, Ferrone C, Fong ZV, Warshaw AL, Lillemoe KD, Fernandez-del Castillo C. Preoperative biliary drainage does not increase major complications in pancreaticoduodenectomy: a large single center experience from the Massachusetts General Hospital. J Hepatobiliary Pancreat Sci. 2016;23:181–7. CrossRefPubMed
- Predictive factors of late cholangitis in patients undergoing pancreaticoduodenectomy
- BioMed Central
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