Search

Background: As complete prevention of postoperative pancreatic fistula (POPF) after pancreatic surgery remains difficult, many risk factors for clinically relevant POPF (CR-POPF) have been reported. However, their clinical impact could be limited because all previous reports included patients without biochemical leakage (BL) that rarely developed to CR-POPF. Therefore, a new strategy for identifying high-risk patients who develop delayed complications from patients with confirmed BL and for implementing interventions for such patients in the early postoperative period is required. This study aimed to examine the role of fistulography in predicting CR-POPF from confirmed BL. Methods: Consecutive patients diagnosed with BL on postoperative day 3 after pancreaticoduodenectomy (PD) or distal pancreatectomy (DP) from January 2013 to June 2015 in our institution were included. Fistulography was performed 1 week after the operation, and the associations between findings on fistulography and delayed complications associated with POPF were evaluated. Results: Eighty-four (37%) of 227 patients who underwent PD and 45 (48%) of 94 patients who underwent DP were included and divided to two groups according to fistulographic findings (simple type, n = 107, 83%; cavity type, n = 22, 17%). The latter finding was associated with a greater morbidity rate (Clavien–Dindo grade ≥ 2: 36% vs 59%, p = 0.018) and a worse final POPF grade (B/C 64% vs 95%, p = 0.003). In the multivariate analysis, cavity type on fistulography was a significant predictive factor for grade B/C POPF. Conclusions: Fistulography is a useful examination for identifying patients with a high risk of developing delayed complications associated with POPF. [ABSTRACT FROM AUTHOR]

Background: It is unclear how early liver recurrence negatively affects survival in patients undergoing surgery for colorectal liver metastases (CLM) and whether to perform re-hepatectomy for early recurrence is still controversial. We aimed to evaluate the prognostic value of re-hepatectomy for early recurrence of CLM. Methods: We reviewed 634 patients undergoing initial hepatectomy for CLM between 2004 and 2015. In 131 patients (20.7%), liver recurrence occurred within 6 months after surgery (early recurrence group [ER]). Recurrence pattern and survivals of ER were compared with those of 150 patients (23.7%) who had liver recurrence more than 6 months after surgery (late recurrence group [LR]). Re-hepatectomy was indicated for resectable disease regardless of the timing of recurrence without using preoperative chemotherapy. Results: The 5-year overall survival (OS) rates after initial hepatectomy in ER (24.0%) were worse than those in LR (57.7%, p < 0.01). Although the incidence of concomitant extrahepatic recurrence was not different between ER and LR, the rate of re-hepatectomy for recurrence confined to the liver in ER (72.5% [58/80]) was lower than that in LR (88.9% [96/108], p < 0.01). In ER, re-hepatectomy was found to independently improve survival (HR: 6.479, p < 0.01), offering the 5-year OS rate after re-hepatectomy of 45.2%. The sites and timing of re-recurrence after re-hepatectomy were not different between ER and LR. Conclusions: Impaired survival of early liver recurrence is attributed to extensive liver recurrence. However, re-hepatectomy indicated based on resectability is associated with improved survival in patients with early recurrence, tempering the re-recurrence mode. [ABSTRACT FROM AUTHOR]

Background: The clinical course of hepatectomy in patients with preexisting bilioenteric anastomosis (BEA) is poorly understood. The aim of this study was to evaluate the potential influence of preexisting BEA on organ/space surgical site infection (SSI) after hepatectomy. Methods: We analyzed consecutive hepatectomies performed between March 2005 and January 2015. Patients' background, operative results, and complications were compared between hepatectomies with and without preexisting BEA. Results: Twenty-two hepatectomies with preexisting BEA were identified among 1745 hepatectomies. The rate of organ/space SSI was much higher in hepatectomies with preexisting BEA than in those without preexisting BEA (40.9 vs. 6.4 %, P < 0.001). Multivariate analyses identified four variables as independent factors associated with organ/space SSI: liver-directed chemotherapy [odds ratio 5.06 (95 % confidence interval 2.29-10.54), P < 0.001], operative time ≥ 300 min [2.40 (1.30-4.54), P = 0.006], estimated blood loss ≥ 500 ml [2.34 (1.26-4.31), P < 0.001], and preexisting BEA [12.08 (4.54-31.32), P < 0.001]. A higher rate of organisms from intestinal flora was detected in organ/space SSI after hepatectomies with preexisting BEA (77.8 vs. 21.3 % without BEA, P = 0.002). Analysis of hepatectomies with preexisting BEA identified selection of antibiotics for prophylaxis as the sole risk factor for organ/space SSI ( P = 0.049 for cefazolin versus other antibiotics targeting intestinal flora). Conclusions: Preexisting BEA is an independent risk factor for the development of organ/space SSI after hepatectomy. Antibiotics targeting intestinal flora are strongly recommended for prophylaxis of infectious complications. [ABSTRACT FROM AUTHOR]