Pancreatic Cancer Clinical Trial
Official title:
Colonization of Bile Ducts and Postoperative Infectious Complications of Pancreaticoduodenectomies
The aim of the present prospective study was, first, to verify the correlation between
biliary colonization and postoperative infectious complications, and secondarily to asses
morbidity and mortality for patients who underwent pancreaticoduodenectomy.
The hypothesis is that a proportion of post-operative infections after
pancreaticoduodenectomy is due to bacteria that colonize the bile ducts during the
preoperative period.
Pancreaticoduodenectomy is part of the curative treatment of periampullary neoplasms.
Postoperative mortality for this procedure is between 1 and 5 %, and morbidity ranging from
30 to 50%. Infectious complications, with pancreatic fistula and gastric delayed empting, are
an important part of this morbidity, affecting nearly 35% of patients.
One of the risk factors of infectious complications is the presence of a preoperative
obstructive jaundice, due to obstruction of bile ducts by the tumor. In this case, it is
proposed to perform a preoperative drainage of the bile ducts, preferably by endoscopic
procedure (ERCP), associated with the placement of a endoprosthesis. However, this procedure
is controversial, this one increasing postoperative morbidity, and in particular the rate of
infectious complications. One explanation of these events is the bacteriological
contamination of the bile ducts during the endoscopic procedure. In addition, it has been
observed for the patients who have benefited from preoperative drainage, the biliary flora is
predominantly polymicrobial and may contain multiresistant nosocomial germs, unlike patients
who have not benefited from this procedure, whose biliary flora is predominantly sterile or
monomicrobial. This colonization by multiresistant germs may have consequences in the
postoperative period, in fact, up to 49% of the germs found in the bile samples are also
found in the samples taken during postoperative infectious events. This microbial release
could make it more difficult to take care of postoperative infections, with less efficacy of
conventional antibiotic treatments.
The aim of the present prospective study was, first, to verify the correlation between
biliary colonization and postoperative infectious complications, and secondarily to asses
morbidity and mortality in patients who underwent pancreaticoduodenectomy. Patients whit
colonized bile and patients with sterile bile were compared for these outcomes.
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