Prognosis of Postoperative Cholangitis Following Pancreaticoduodenectomy: A Single-Centered Retrospective Cohort Study

Abstract

Introduction Postoperative cholangitis (POC) after pancreaticoduodenectomy is a serious complication. However, the prognostic factors are unclear. We aimed to investigate the relationships between biliary lesions and prognosis in patients with cholangitis after pancreaticoduodenectomy. Methods We conducted a single-centered retrospective cohort study. The unit of analysis was hospital admissions. We extracted patients who underwent pancreaticoduodenectomy from 2010 to 2018, and have a record of hospitalization of cholangitis from January 2010 to October 2019. We defined the bile duct lesions as the presence of one of the following: biliary stent, intrahepatic bile duct dilatation, intrahepatic bile duct stones, or common bile duct stones on imaging studies. The primary outcome was the treatment failure of POC. We defined the failure as a composite outcome of death within 30 days of initiation of treatment, relapse during treatment, or recurrence of cholangitis. We used logistic regression analysis to examine the association between the presence of bile duct lesions and the occurrence of outcomes. Results Of 154 admissions included in the present study, 120 cases (77.9%) were with bile duct lesions. Bile duct lesions were associated with the treatment failure (crude odds ratio [OR] 2.56, 95% confidence intervals [CI] 1.08 to 6.32; adjusted OR 2.81, 95%CI 1.08 to 7.34). Conclusions Clinicians should follow the patient of POC with bile duct lesions on imaging carefully because of the high risk of treatment failure, especially for recurrence. Further studies are warranted to confirm our results.

Keywords: choledochojejunostomy; pancreaticoduodenectomy; postoperative cholangitis; prognostic factor; retrospective cohort study.

Figure 1. Patients flow chart

* Cholangitis includes the following diseases: cholangitis, retrograde cholangitis, acute suppurative cholangitis, acute cholangitis, stenosing cholangitis, recurrent cholangitis, obstructive suppurative cholangitis, and postoperative cholangitis as recorded disease names.  † Bile duct drainage includes the following procedures: external biliary drainage, percutaneous transhepatic biliary drainage, percutaneous transhepatic biliary stenting, endoscopic nasobiliary drainage, endoscopic biliary dilatation, endoscopic biliary stenting, endoscopic ultrasound-guided biliary drainage. †† The Diagnostic criteria for cholangitis are based on the Tokyo Guidelines 2018. In cases clinically diagnosed as cholangitis but outside the diagnostic criteria, those with elevated biliary enzymes were included, and those without elevated biliary enzymes were excluded.