Background Among various prognostic factors of pancreatic cancer, preoperative clinical information is obtained by imaging modality. This study aimed to evaluate clinical usefulness of preoperative carbohydrate antigen and preoperative standard uptake value in 18F‐fluorodeoxyglucose positron emission tomography as predictive biological markers for resectable pancreatic ductal adenocarcinoma. Methods A total of 189 patients with PDAC who underwent preoperative PET–computed tomography were evaluated. Patients underwent neoadjuvant chemotherapy, and R2 resection was excluded. The correlation between SUVmax and clinicopathologic parameters was analyzed. The C‐tree statistical method was used to estimate cutoff values of logCA19‐9 and SUVmax for survival rate. A multivariate analysis was conducted to identify prognostic factors for overall survival. Results The median duration of OS was 26 months, and the 5‐year survival rate was 22.4%. The optimal cutoff values for CA19‐9 level was 150 U/mL and SUVmax was 5.5. When subjects were divided into three groups according to the combination of CA19‐9 level and SUVmax from C‐tree (high‐risk group, CA19‐9 > 150 U/mL and SUVmax > 5.5; intermediate‐risk group, CA19‐9 ≤ 150 U/mL and SUVmax > 5.5 or CA19‐9 > 150 U/mL and SUVmax ≤ 5.5; and low‐risk group, CA19‐9 ≤ 150 U/mL and SUVmax ≤ 5.5), there was a significant 5YSR difference (5.6%, 24.3%, and 36.5%, P < .001). The multivariate analysis revealed high SUVmax, high preoperative CA19‐9 level, venous invasion, and adjuvant chemotherapy were prognostic factors of OS. Conclusions CA19‐9 and SUVmax are strong prognostic biological factors in resectable PDAC. Moreover, patients with high CA19‐9 level and SUVmax are not indicated for upfront surgery.

Purpose In general, bile is normally sterile. However, there are reports bactibilia may occur in certain instances, though the causal factors are unclear. We analyzed possible preoperative predictors of bactibilia upon cholecystectomy. Methods Bile samples were collected during cholecystectomies from November 2018 to November 2019. A total of 428 open or laparoscopic cholecystectomies were performed. Preoperative, intraoperative, and postoperative variables were compared between the culture-positive and culture-negative groups. Results One hundred fifty-seven patients (36.7%) were culture-positive. Gram-negative bacteria (95 [61.0%]) were more common. Escherichia coli (38 [40.0%]) and Enterobacter (22 [23.2%]) were the most common species. In univariate analysis, age of ≥70 years (P < 0.001), male sex (P < 0.001), high American Society of Anesthesiologists physical status grades (P = 0.001), diabetes mellitus (P = 0.002), jaundice (P = 0.007), high Tokyo Guideline grades (P = 0.008), percutaneous transhepatic gallbladder drainage (PTGBD; P < 0.001), endoscopic retrograde cholangiopancreatography (ERCP; P < 0.001) were identified as a risk factors for bactibilia. In multivariate analysis, age of ≥70 years (hazard ratio [HR], 2.874; 95% confidence interval [CI], 1.769–4.670; P = 0.001), ERCP (HR, 9.001; 95% CI, 4.833–16.75; P < 0.001), and PTGBD (HR, 2.866; 95% CI, 1.440–4.901; P = 0.002) were independent risk factors for bactibilia. Conclusion Among patients who underwent cholecystectomy, those who were elderly, symptomatic, and underwent preoperative drainage were more likely to have bactibilia. In such cases, surgeons should take care to prevent bile leakage during surgery and consider administering appropriate antibiotics.

Introduction:In general, bile is sterile in normal status. However, there have been reports that bactibilia may exist at certain instances and its causal factors have not fully elucidated yet. To investigate the factors affecting bactiblia, we analyzed possible preoperative predictors and microflora in bile. Methods: Bile samples were collected for culture during cholecystectomies from November 2018 to November 2019. A total of 463 laparoscopic cholecystectomies were performed. Preoperative, intraoperative, and postoperative variables were compared between culture-positive and culture-negative groups. Results: Of all patients, 157 (36.7%) of patients were culture-positive. Gram-negative bacteria (92, 58.6%) were more common, and Escherichia coli (43, 46.7%) and Klebsiella (20, 21.7%) were common species. The culture-positive group was older (53.9 ± 16.2 vs. 68.4 ± 12.3, p < 0.001), more symptomatic (66.8% vs. 79.6%, p < 0.001), underwent more preoperative procedures including endoscopic retrograde cholangiopancreatography (18 vs. 54, p < 0.001), percutaneous transhepatic gallbladder drainage (24 vs. 41, p < 0.001), and had more cases of emergency hospitalization (32.8% vs. 63.1%, p < 0.001) than culture-negative group. In multivariate analysis, age (HR 2.874, 95% CI 1.769-4.670, p < 0.001), abdominal pain (HR 1.730, 95% CI 1.026-2.919, p = 0.002), ERCP (HR 9.00, 95% CI 4.833-16.75, p < 0.001), and PTGBD (HR 2.86, 95% CI 1.440-4.901, p = 0.002) were independent factors related with bactibila. Conclusions: Among the patients who underwent laparoscopic cholecystectomy, the elderly, symptomatic, and preoperative drainage patients were more likely to have bacteria in the bile. In such cases, surgeon should be careful to prevent bile leakage during surgery, and consider administration of antibiotics that could cover gram-negative bacteria.

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