The clinical features of late postoperative cholangitis following pancreaticoduodenectomy brought on by conditions other than cancer recurrence: a single-center retrospective study

Abstract

Background Postoperative cholangitis is a late complication of pancreaticoduodenectomy (PD). This study aimed to elucidate the pathogenesis of post-PD cholangitis (PPDC) and explore its optimal treatment. Methods We retrospectively analyzed 210 patients who underwent PD at our institute between 2009 and 2018. Patients who underwent follow-up for less than 1 year or had cholangitis caused by cancer recurrence were excluded from the analysis. Diagnostic criteria for cholangitis and its severity were determined based on the classification of acute cholangitis provided by the 2018 Tokyo Guidelines (TG18). Results PPDC occurred in 19 (11%) of the 176 included patients. Of these 19 patients, nine experienced more than one episode of cholangitis (total episodes, 36). For 14 patients (74%), the first episode of PPDC occurred within two years after surgery. Based on the TG18, 21 episodes were mild and 15 episodes were moderate; none were severe. Blood culture test results were positive for 16 of 24 episodes. Most patients were hospitalized and treated with intravenous antibiotics (median, seven days). The blood test values improved promptly after treatment was started. Four patients with recurrent cholangitis underwent endoscopic examination, and three of them had anastomotic stenosis of the hepaticojejunostomy. The univariate and multivariate analyses did not indicate any significant predictive factors for PPDC development. Conclusion Mild and moderate PPDC occurred and improved with short-term antimicrobial treatment. Temporary reflux into the intrahepatic bile ducts may have been the cause of PPDC while anastomotic stenosis may be involved in recurrent cases.

Risk factors for postoperative cholangitis after pancreaticoduodenectomy and evaluation of internal stenting on hepaticojejunostomy: A single‐center propensity score‐based analysis

“…POC is one of the early and late complications after PD, with a reported frequency of 5.7%-21.1%. 3,4,[9][10][11][12] In the present study, total POC, E-POC, and L-POC occurrence were 26, 15.4, and 14.8%, respectively; hence, these results align with the results of previous studies. POC after PD sometimes occurs repeatedly, 3 sometimes increasing the length and cost of hospitalization.…”

“…One article reported that the median duration from PD to POC onset was 275 days (range, 30–3037) 3 . This duration was similar to our results; however, another study showed that the percentage of patients who experienced first‐episode POC more than 2 years after PD was 27% 10 . Hence, the occurrence of L‐POC may have increased if the follow‐up period of our study had been longer.…”

“…3 This duration was similar to our results; however, another study showed that the percentage of patients who experienced first-episode POC more than 2 years after PD was 27%. 10 Hence, the occurrence of L-POC may have increased if the follow-up period of our study had been longer. Third, we did not perform external biliary drainage on HJ; hence, we could not evaluate the effectiveness of this method for preventing POC or other biliary complications.…”

Recent trends in organ‐preserving pancreatectomy: Its problems and clinical advantages compared with other standard pancreatectomies

“…The long-term complications after PD have been reported as nutritional disorder, postoperative cholangitis due to bile duct resection, 81,82 and exocrine [83][84][85] and endocrine dysfunction, 86 and several studies on the comparisons of such long-term complications between the DPPR and PD groups are reported in Table 3.…”

“…The long‐term complications after PD have been reported as nutritional disorder, postoperative cholangitis due to bile duct resection, 81,82 and exocrine 83–85 and endocrine dysfunction, 86 and several studies on the comparisons of such long‐term complications between the DPPR and PD groups are reported in Table 3. Horiguchi et al 7 revealed that both exocrine (evaluated by the 13 C‐trioctanoin breath test) and endocrine functions (evaluated by HbA1c) were superior in the DPPHR group than in the PPPD group.…”