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Perioperative pancreaticoduodenectomy management strategy focusing on postoperative early drain colonization

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Abstract

Purpose

Pancreatoduodenectomy (PD) is a highly invasive procedure. Intra-abdominal infections and pancreatic fistulas are strongly correlated complications. In the present study, we identified the risk factors for postoperative early drain colonization (POEDC) and established a perioperative management strategy.

Methods

A total of 205 patients who underwent pancreatoduodenectomy were included in the study. POEDC was defined as a positive drain fluid culture before postoperative day (POD) 4. We retrospectively investigated the correlation between POEDC, postoperative outcomes, and clinical factors.

Results

POEDC was observed in 26 patients (12.6%) with poor postoperative outcomes, including pancreatic fistulas (P < 0.001). A multivariate analysis demonstrated a correlation between these postoperative outcomes and the age (P = 0.002), body mass index (BMI) (P = 0.002), procalcitonin (PCT) level (P < 0.001), and drain amylase level on POD 1 (P = 0.032). Enterococcus was detected most frequently, being found in 15 patients.

Conclusion

We observed a strong correlation between POEDC and poor postoperative outcomes. The BMI, age, and PCT and drain amylase level on POD 1 should be considered POEDC risk factors, with the need to propose an antibiotic perioperative strategy. POEDC control may represent the key to improving postoperative outcomes after PD.

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Funding

This study did not receive grants from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Hepatobiliary and Pancreatic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa-Machi, Maebashi, Gunma, 371-8511, Japan

    Akira Watanabe, Norifumi Harimoto, Kenichiro Araki, Takamichi Igarashi, Mariko Tsukagoshi, Norihiro Ishii, Kei Hagiwara & Ken Shirabe

  2. Department of Clinical Laboratory Medicine, Gunma University, 3-39-22 Showa-Machi, Maebashi, Gunma, 371-8511, Japan

    Katsuhiko Tsunekawa & Masami Murakami

Authors
  1. Akira Watanabe
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  2. Norifumi Harimoto
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Correspondence to Norifumi Harimoto.

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Watanabe, A., Harimoto, N., Araki, K. et al. Perioperative pancreaticoduodenectomy management strategy focusing on postoperative early drain colonization. Surg Today (2024). https://doi.org/10.1007/s00595-024-02810-4

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