Prognostic impact of postoperative infection after resection of biliary malignancy: A multicenter retrospective cohort study.

Aug 21, 2023

Experts: Masahiro Iseki,Masamichi Mizuma,Michiaki Unno,Hiroshi Maruyama,Shinji Akagi,Mitsugi Shimoda,Kenichiro Uemura,Toru Inoue,Hisanori Shiomi,Manabu Watanabe,Minako Kobayashi,Akihisa Matsuda,Yusuke Mizuuchi,Taku Aoki,Hiroji Shinkawa,Risa Takahata,Kenta Makino,Hiroki Arai,Yasuyuki Yokoyama,Shigeru Takeda,Yoshihisa Yaguchi,Yuko Kitagawa

The aim of this study was to investigate the prognostic impact of postoperative infections in patients who underwent resection for biliary malignancy, including intrahepatic cholangiocarcinoma, perihilar cholangiocarcinoma, distal cholangiocarcinoma, gallbladder carcinoma, and carcinoma of the ampulla of Vater.
This study was conducted in an 11-center retrospective cohort study. Patients with biliary tract cancer who underwent curative resection between April 2013 and March 2015 at 11 institutions in Japan were enrolled. We analyzed the prevalence of postoperative infection, infection-related factors, and prognostic factors.
Of the total 290 cases, 33 were intrahepatic cholangiocarcinoma, 60 were perihilar cholangiocarcinoma, 120 were distal cholangiocarcinoma, 55 were gallbladder carcinoma, and 22 were carcinoma of the ampulla of Vater. Postoperative infectious complications, including remote infection, were observed in 146 patients (50.3%), and Clavien-Dindo ≥III in 115 patients (39.7%). Postoperative infections occurred more commonly in the patients who received pancreaticoduodenectomy and bile duct resection. Patients with infectious complications had a significantly poorer prognosis than those without (median overall survival 38 months vs 62 months, P = .046). In a diagnosis-specific analysis, although there was no correlation between infectious complications and overall survival in intrahepatic cholangiocarcinoma, perihilar cholangiocarcinoma, distal cholangiocarcinoma, and carcinoma of the ampulla of Vater, infectious complications were a significantly poor prognostic factor in gallbladder carcinoma (P = .031).
Postoperative infection after surgery for biliary tract cancer commonly occurred, especially in patients who underwent pancreaticoduodenectomy and bile duct resection. Postoperative infection is relatively associated with the prognosis of patients with biliary malignancy, especially gallbladder carcinoma.

Copyright © 2023. Published by Elsevier Inc.

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ABOUT THE EXPERTS

Masahiro Iseki,Masamichi Mizuma,Michiaki Unno,Hiroshi Maruyama,Shinji Akagi,Mitsugi Shimoda,Kenichiro Uemura,Toru Inoue,Hisanori Shiomi,Manabu Watanabe,Minako Kobayashi,Akihisa Matsuda,Yusuke Mizuuchi,Taku Aoki,Hiroji Shinkawa,Risa Takahata,Kenta Makino,Hiroki Arai,Yasuyuki Yokoyama,Shigeru Takeda,Yoshihisa Yaguchi,Yuko Kitagawa

Masahiro Iseki

Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan. Electronic address: isekimasahiro@surg.med.tohoku.ac.jp.

Masamichi Mizuma

Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan.

Michiaki Unno

Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan.

Hiroshi Maruyama

Department of Surgery, Nippon Medical School, Tama-Nagayama Hospital, Tokyo, Japan; Clinical Research Support Committee, Japan Society for Surgical Infection, Tokyo, Japan.

Shinji Akagi

Clinical Research Support Committee, Japan Society for Surgical Infection, Tokyo, Japan; Department of Surgery, Mazda Hospital, Hiroshima, Japan.

Mitsugi Shimoda

Clinical Research Support Committee, Japan Society for Surgical Infection, Tokyo, Japan; Department of Gastroenterological Surgery, Ibaraki Medical Center, Tokyo Medical University, Ibaraki, Japan.

Kenichiro Uemura

Clinical Research Support Committee, Japan Society for Surgical Infection, Tokyo, Japan; Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan.

Toru Inoue

Clinical Research Support Committee, Japan Society for Surgical Infection, Tokyo, Japan; Department of Gastrointestinal Surgery, Osaka City General Hospital, Japan.

Hisanori Shiomi

Clinical Research Support Committee, Japan Society for Surgical Infection, Tokyo, Japan; Department of Surgery, Nagahama Red Cross Hospital, Shiga, Japan.

Manabu Watanabe

Clinical Research Support Committee, Japan Society for Surgical Infection, Tokyo, Japan; Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan.

Minako Kobayashi

Clinical Research Support Committee, Japan Society for Surgical Infection, Tokyo, Japan; Department of Infection Control and Prevention, Nippon Medical School, Musashikosugi Hospital, Kanagawa, Japan.

Akihisa Matsuda

Clinical Research Support Committee, Japan Society for Surgical Infection, Tokyo, Japan; Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan.

Yusuke Mizuuchi

Clinical Research Support Committee, Japan Society for Surgical Infection, Tokyo, Japan; Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

Taku Aoki

Clinical Research Support Committee, Japan Society for Surgical Infection, Tokyo, Japan; Department of Hepato-Biliary-Pancreatic Surgery, Dokkyo Medical University, Tochigi, Japan.

Hiroji Shinkawa

Clinical Research Support Committee, Japan Society for Surgical Infection, Tokyo, Japan; Department of Hepatobiliary-Pancreatic Surgery, Osaka Metropolitan University Graduate School of Medicine, Japan.

Risa Takahata

Clinical Research Support Committee, Japan Society for Surgical Infection, Tokyo, Japan; Department of Medical Risk Management and Infection Control, National Defense Medical Collage, Saitama, Japan.

Kenta Makino

Clinical Research Support Committee, Japan Society for Surgical Infection, Tokyo, Japan; Department of Surgery, Graduate School of Medicine, Kyoto University, Japan.

Hiroki Arai

Clinical Research Support Committee, Japan Society for Surgical Infection, Tokyo, Japan; Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, Japan.

Yasuyuki Yokoyama

Clinical Research Support Committee, Japan Society for Surgical Infection, Tokyo, Japan; Department of Digestive Surgery, Nippon Medical School Musashikosugi Hospital, Kanagawa, Japan.

Shigeru Takeda

Clinical Research Support Committee, Japan Society for Surgical Infection, Tokyo, Japan; Department of Gastroenterological, Breast, and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Japan.

Yoshihisa Yaguchi

Clinical Research Support Committee, Japan Society for Surgical Infection, Tokyo, Japan; Department of Surgery, Sassa General Hospital, Tokyo, Japan.

Yuko Kitagawa

Department of Surgery, Keio University School of Medicine, Tokyo, Japan; The Japan Society of Surgical Infection, Tokyo, Japan.