Refractory Long-Term Cholangitis After Pancreaticoduodenectomy: A Retrospective Study
- 416 Downloads
Postoperative cholangitis is one of the major late complications after pancreaticoduodenectomy (PD), and recurrent cholangitis has a negative impact on patients’ quality of life. However, detailed reports are scarce. The aim of this study was to investigate the clinical features of postoperative cholangitis after PD.
Between January 2007 and December 2013, 155 consecutive patients underwent PD. Of these, 113 patients were included in this study. Cholangitis was diagnosed according to the criteria in the revised Tokyo Guidelines 2013, and repeated cholangitis with three or more episodes was defined as ‘refractory cholangitis’. Data from patients with refractory cholangitis were retrospectively analyzed.
Refractory cholangitis was observed in 21 patients (18.6%). Of these, 17 patients experienced cholangitis within 1 year after PD, and 10 patients had biliary strictures. These patients required an average of two interventional or endoscopic treatments for stricture dilatation, which led to remission. The 2-year cumulative incidence rate for refractory cholangitis was 18.9% (95% CI 11.65–26.15). Multivariate analysis revealed five risk factors for developing refractory cholangitis: benign disease (odds ratio [OR] 18.52; P = 0.001), long operation time (OR 18.73; P = 0.002), elevated C-reactive protein (OR 6.55; P = 0.014), elevated alkaline phosphatase (OR 6.03; P = 0.018), and the presence of pneumobilia (OR 28.81; P = 0.009).
Postoperative refractory cholangitis after PD usually developed within a year. Almost half of the patients had biliary strictures, and aggressive dilatation might be effective to achieve remission in these patients.
KeywordsCholangitis Obstructive Jaundice Choledochal Cyst Biliary Stricture Delay Gastric Emptying
We would like to thank the radiologists and gastroenterologists at our hospital who greatly contributed to the clinical diagnosis and treatment of cholangitis in this study.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 5.Kimura W, Miyata H, Gotoh M et al (2014) A pancreaticoduodenectomy risk model derived from 8575 cases from a national single-race population (Japanese) using a web-based data entry system: the 30-day and in-hospital mortality rates for pancreaticoduodenectomy. Ann Surg 259:773–780CrossRefPubMedGoogle Scholar
- 6.Keck T, Wellner UF, Bahra M et al (2016) Pancreatogastrostomy versus pancreatojejunostomy for RECOnstruction after PANCreatoduodenectomy (RECOPANC, DRKS 00000767): perioperative and long-term results of a multicenter randomized controlled trial. Ann Surg 263:440–449CrossRefPubMedPubMedCentralGoogle Scholar
- 17.Friess H, Ho CK, Kleef J et al (2007) Pancreaticoduodenectomy, distal pancreatectomy, segmental pancreatectomy, total pancreatectomy, and transduodenal resection of the papilla of Vater. In: Surgery of the liver, biliary tract, and pancreas. Saunders, Philadelphia, pp 877–903Google Scholar
- 27.Tsalis K, Antoniou N, Koukouritaki Z et al (2014) Successful treatment of recurrent cholangitis by constructing a hepaticojejunostomy with long Roux-en-Y limb in a long-term surviving patient after a Whipple procedure for pancreatic adenocarcinoma. Am J Case Rep 15:348–351CrossRefPubMedPubMedCentralGoogle Scholar