Adaptation of Antibiotics and Antifungal Strategy to Preoperative Biliary Drainage to Improve Postoperative Outcomes After Pancreatic Head Resection

Overview

Journal World J Surg

Publisher Wiley

Specialty General Surgery

Date 2024 Dec 16

PMID 39681975

Authors

Fabio Giannone

Charles Lagarrigue

Oronzo Ligurgo

Lina Jazaerli

Paul Michel Mertes

Olivier Collange

Patrick Pessaux

Affiliations

Soon will be listed here.

Abstract

Background: Biliary contamination significantly correlates with major comorbidities during pancreatic head resection. Recently, a piperacillin-tazobactam prophylaxis demonstrated a lower rate of infectious complications (IC) and postoperative pancreatic fistula (POPF) in this population. However, bacterial contamination is rare in patients without a preoperative biliary drainage (PBD) and probably could not benefit from this antibiotic. Furthermore, little is known about the role of biliary fungal contamination.

Method: All retrospective cases undergoing pancreatic head resection with intraoperative biliary sample were included. Postoperative outcomes of patients with a piperacillin-tazobactam-based treatment were compared to cases in which a narrow-spectrum antibiotic was administrated, stratified according to the use of a PBD. The same analysis was repeated for antifungal treatment administration.

Results: Among the 205 cases included, PBD was necessary in 127 patients (62%). Broad-spectrum treatment was associated with fewer overall and clinically relevant POPF (p = 0.001 and p = 0.004), overall morbidity (p = 0.044), and overall IC (p = 0.018), but only in the PBD group. Similarly, antifungal treatment was significantly associated with some specific IC only in the PBD group. At multivariable analysis, antifungal therapy in the whole cohort (p = 0.029) and the use of a piperacillin-tazobactam (p = 0.007) treatment in patients with a PBD were independently associated with a reduced risk of a clinically relevant POPF.

Conclusions: A broad-spectrum antibiotic therapy reduces overall morbidity after pancreatic head resection, but only in cases with a history of PBD. Furthermore, the use of an antifungal prophylaxis or therapy should be further investigated in these patients because it may reduce the risk of some IC.

References

Wente M, Bassi C, Dervenis C, Fingerhut A, Gouma D, Izbicki J . Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery. 2007; 142(5):761-8. DOI: 10.1016/j.surg.2007.05.005. View

DeOliveira M, Winter J, Schafer M, Cunningham S, Cameron J, Yeo C . Assessment of complications after pancreatic surgery: A novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann Surg. 2006; 244(6):931-7. PMC: 1856636. DOI: 10.1097/01.sla.0000246856.03918.9a. View

Ho C, Kleeff J, Friess H, Buchler M . Complications of pancreatic surgery. HPB (Oxford). 2008; 7(2):99-108. PMC: 2023932. DOI: 10.1080/13651820510028936. View

Degrandi O, Buscail E, Martellotto S, Gronnier C, Collet D, Adam J . Perioperative antibiotherapy should replace prophylactic antibiotics in patients undergoing pancreaticoduodenectomy preceded by preoperative biliary drainage. J Surg Oncol. 2019; 120(4):639-645. DOI: 10.1002/jso.25622. View

. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013; 310(20):2191-4. DOI: 10.1001/jama.2013.281053. View

Dindo D, Demartines N, Clavien P . Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004; 240(2):205-13. PMC: 1360123. DOI: 10.1097/01.sla.0000133083.54934.ae. View

Scheufele F, Schorn S, Demir I, Sargut M, Tieftrunk E, Calavrezos L . Preoperative biliary stenting versus operation first in jaundiced patients due to malignant lesions in the pancreatic head: A meta-analysis of current literature. Surgery. 2017; 161(4):939-950. DOI: 10.1016/j.surg.2016.11.001. View

Windisch O, Frossard J, Schiffer E, Harbarth S, Morel P, Buhler L . Microbiologic Changes Induced by Biliary Drainage Require Adapted Antibiotic Prophylaxis during Duodenopancreatectomy. Surg Infect (Larchmt). 2019; 20(8):677-682. DOI: 10.1089/sur.2019.088. View

Sato A, Masui T, Nakano K, Sankoda N, Anazawa T, Takaori K . Abdominal contamination with Candida albicans after pancreaticoduodenectomy is related to hemorrhage associated with pancreatic fistulas. Pancreatology. 2017; 17(3):484-489. DOI: 10.1016/j.pan.2017.03.007. View

10.

Clavien P, Barkun J, De Oliveira M, Vauthey J, Dindo D, Schulick R . The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009; 250(2):187-96. DOI: 10.1097/SLA.0b013e3181b13ca2. View

11.

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(42):e22714. PMC: 7571999. DOI: 10.1097/MD.0000000000022714. View

12.

Lermite E, Pessaux P, Teyssedou C, Etienne S, Brehant O, Arnaud J . Effect of preoperative endoscopic biliary drainage on infectious morbidity after pancreatoduodenectomy: a case-control study. Am J Surg. 2008; 195(4):442-6. DOI: 10.1016/j.amjsurg.2007.03.016. View

13.

Van Der Gaag N, Rauws E, van Eijck C, Bruno M, van der Harst E, Kubben F . Preoperative biliary drainage for cancer of the head of the pancreas. N Engl J Med. 2010; 362(2):129-37. DOI: 10.1056/NEJMoa0903230. View

14.

Itoyama R, Okabe H, Yamashita Y, Kitamura F, Uemura N, Nakao Y . Intraoperative bile culture helps choosing antibiotics in pancreaticoduodenectomy: Mechanistic profiling study of complex rink between bacterobilia and postoperative complications. J Hepatobiliary Pancreat Sci. 2021; 28(12):1107-1114. DOI: 10.1002/jhbp.887. View

15.

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(3):725-30. DOI: 10.1016/j.surg.2016.03.032. View

16.

Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M . The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After. Surgery. 2017; 161(3):584-591. DOI: 10.1016/j.surg.2016.11.014. View

17.

Fathi A, Jackson T, Barati M, Eghbalieh B, Siegel K, Siegel C . Extended Perioperative Antibiotic Coverage in Conjunction with Intraoperative Bile Cultures Decreases Infectious Complications after Pancreaticoduodenectomy. HPB Surg. 2016; 2016:3031749. PMC: 4842379. DOI: 10.1155/2016/3031749. View

18.

di Mola F, Tavano F, Rago R, De Bonis A, Valvano M, Andriulli A . Influence of preoperative biliary drainage on surgical outcome after pancreaticoduodenectomy: single centre experience. Langenbecks Arch Surg. 2014; 399(5):649-57. DOI: 10.1007/s00423-014-1184-8. View

19.

De Pastena M, Paiella S, Marchegiani G, Malleo G, Ciprani D, Gasparini C . Postoperative infections represent a major determinant of outcome after pancreaticoduodenectomy: Results from a high-volume center. Surgery. 2017; 162(4):792-801. DOI: 10.1016/j.surg.2017.05.016. View

20.

Okano K, Suzuki Y . Influence of bile contamination for patients who undergo pancreaticoduodenectomy after biliary drainage. World J Gastroenterol. 2019; 25(47):6847-6856. PMC: 6931003. DOI: 10.3748/wjg.v25.i47.6847. View