Late cholangitis after pancreatoduodenectomy: A common complication with or without anatomical biliary obstruction

Anne Claire Henry; Youcef Salaheddine; Jessica J Holster; Lois A Daamen; Marco J Bruno; Wouter J M Derksen; Lydi M J W van Driel; Casper H van Eijck; Krijn P van Lienden; I Quintus Molenaar; Hjalmar C van Santvoort; Frank P Vleggaar; Bas Groot Koerkamp; Robert C Verdonk

doi:10.1016/j.surg.2024.06.044

Late cholangitis after pancreatoduodenectomy: A common complication with or without anatomical biliary obstruction

Anne Claire Henry, Youcef Salaheddine, Jessica J Holster, Lois A Daamen, Marco J Bruno, Wouter J M Derksen, Lydi M J W van Driel, Casper H van Eijck, Krijn P van Lienden, I Quintus Molenaar, Hjalmar C van Santvoort, Frank P Vleggaar, Bas Groot Koerkamp, Robert C Verdonk^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: Postoperative cholangitis is a common complication after pancreatoduodenectomy that can occur with or without anatomical biliary obstruction. This study aimed to investigate the incidence, diagnosis, treatment, and risk factors of cholangitis after pancreatoduodenectomy.

METHODS: We performed a retrospective cohort study of consecutive patients who underwent pancreatoduodenectomy in 2 Dutch tertiary pancreatic centers (2010-2019). Primary outcome was postoperative cholangitis, defined as systemic inflammation with abnormal liver tests without another focus of infection, at least 1 month after resection. Diagnostic and therapeutic strategies were evaluated. Two types of postoperative cholangitis were distinguished; obstructive cholangitis (benign stenosis of the hepaticojejunostomy) and nonobstructive cholangitis. Potential risk factors were identified using logistic regression analysis.

RESULTS: Postoperative cholangitis occurred in 93 of 900 patients (10.3%). Median time to first episode of cholangitis was 8 months (interquartile range 4-16) after pancreatoduodenectomy. Multiple episodes of cholangitis occurred in 44 patients (47.3%) and readmission was necessary in 83 patients (89.2%). No cholangitis-related mortality was observed. Obstructive cholangitis was seen in 37 patients (39.8%) and nonobstructive cholangitis in 56 patients (60.2%). Surgery was performed for cholangitis in 7 patients (7.5%) and consisted of revision of the hepaticojejunostomy or elongation of the biliary limb. Postoperative biliary leakage (odds ratio 2.56; 95% confidence interval 1.42-4.62; P = .0018) was independently associated with postoperative cholangitis.

CONCLUSION: Postoperative cholangitis unrelated to cancer recurrence was seen in 10% of patients after pancreatoduodenectomy. Nonobstructive cholangitis was more common than obstructive cholangitis. Postoperative biliary leakage was an independent risk factor.

Original language	English
Pages (from-to)	1207-1214
Number of pages	8
Journal	Surgery
Volume	176
Issue number	4
Early online date	24 Jul 2024
DOIs	https://doi.org/10.1016/j.surg.2024.06.044
Publication status	Published - Oct 2024

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10.1016/j.surg.2024.06.044

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Henry, A. C., Salaheddine, Y., Holster, J. J., Daamen, L. A., Bruno, M. J., Derksen, W. J. M., van Driel, L. M. J. W., van Eijck, C. H., van Lienden, K. P., Molenaar, I. Q., van Santvoort, H. C., Vleggaar, F. P., Groot Koerkamp, B., & Verdonk, R. C. (2024). Late cholangitis after pancreatoduodenectomy: A common complication with or without anatomical biliary obstruction. Surgery, 176(4), 1207-1214. https://doi.org/10.1016/j.surg.2024.06.044

@article{fc634f341e284cf78083d1b85adbdce0,

title = "Late cholangitis after pancreatoduodenectomy: A common complication with or without anatomical biliary obstruction",

abstract = "BACKGROUND: Postoperative cholangitis is a common complication after pancreatoduodenectomy that can occur with or without anatomical biliary obstruction. This study aimed to investigate the incidence, diagnosis, treatment, and risk factors of cholangitis after pancreatoduodenectomy.METHODS: We performed a retrospective cohort study of consecutive patients who underwent pancreatoduodenectomy in 2 Dutch tertiary pancreatic centers (2010-2019). Primary outcome was postoperative cholangitis, defined as systemic inflammation with abnormal liver tests without another focus of infection, at least 1 month after resection. Diagnostic and therapeutic strategies were evaluated. Two types of postoperative cholangitis were distinguished; obstructive cholangitis (benign stenosis of the hepaticojejunostomy) and nonobstructive cholangitis. Potential risk factors were identified using logistic regression analysis.RESULTS: Postoperative cholangitis occurred in 93 of 900 patients (10.3%). Median time to first episode of cholangitis was 8 months (interquartile range 4-16) after pancreatoduodenectomy. Multiple episodes of cholangitis occurred in 44 patients (47.3%) and readmission was necessary in 83 patients (89.2%). No cholangitis-related mortality was observed. Obstructive cholangitis was seen in 37 patients (39.8%) and nonobstructive cholangitis in 56 patients (60.2%). Surgery was performed for cholangitis in 7 patients (7.5%) and consisted of revision of the hepaticojejunostomy or elongation of the biliary limb. Postoperative biliary leakage (odds ratio 2.56; 95% confidence interval 1.42-4.62; P = .0018) was independently associated with postoperative cholangitis.CONCLUSION: Postoperative cholangitis unrelated to cancer recurrence was seen in 10% of patients after pancreatoduodenectomy. Nonobstructive cholangitis was more common than obstructive cholangitis. Postoperative biliary leakage was an independent risk factor.",

author = "Henry, {Anne Claire} and Youcef Salaheddine and Holster, {Jessica J} and Daamen, {Lois A} and Bruno, {Marco J} and Derksen, {Wouter J M} and {van Driel}, {Lydi M J W} and {van Eijck}, {Casper H} and {van Lienden}, {Krijn P} and Molenaar, {I Quintus} and {van Santvoort}, {Hjalmar C} and Vleggaar, {Frank P} and {Groot Koerkamp}, Bas and Verdonk, {Robert C}",

note = "Publisher Copyright: {\textcopyright} 2024 Elsevier Inc.",

year = "2024",

month = oct,

doi = "10.1016/j.surg.2024.06.044",

language = "English",

volume = "176",

pages = "1207--1214",

journal = "Surgery",

issn = "0039-6060",

publisher = "Mosby Inc.",

number = "4",

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Henry, AC, Salaheddine, Y, Holster, JJ, Daamen, LA, Bruno, MJ, Derksen, WJM, van Driel, LMJW, van Eijck, CH, van Lienden, KP, Molenaar, IQ , van Santvoort, HC , Vleggaar, FP, Groot Koerkamp, B & Verdonk, RC 2024, 'Late cholangitis after pancreatoduodenectomy: A common complication with or without anatomical biliary obstruction', Surgery, vol. 176, no. 4, pp. 1207-1214. https://doi.org/10.1016/j.surg.2024.06.044

TY - JOUR

T1 - Late cholangitis after pancreatoduodenectomy

T2 - A common complication with or without anatomical biliary obstruction

AU - Henry, Anne Claire

AU - Salaheddine, Youcef

AU - Holster, Jessica J

AU - Daamen, Lois A

AU - Bruno, Marco J

AU - Derksen, Wouter J M

AU - van Driel, Lydi M J W

AU - van Eijck, Casper H

AU - van Lienden, Krijn P

AU - Molenaar, I Quintus

AU - van Santvoort, Hjalmar C

AU - Vleggaar, Frank P

AU - Groot Koerkamp, Bas

AU - Verdonk, Robert C

PY - 2024/10

Y1 - 2024/10

N2 - BACKGROUND: Postoperative cholangitis is a common complication after pancreatoduodenectomy that can occur with or without anatomical biliary obstruction. This study aimed to investigate the incidence, diagnosis, treatment, and risk factors of cholangitis after pancreatoduodenectomy.METHODS: We performed a retrospective cohort study of consecutive patients who underwent pancreatoduodenectomy in 2 Dutch tertiary pancreatic centers (2010-2019). Primary outcome was postoperative cholangitis, defined as systemic inflammation with abnormal liver tests without another focus of infection, at least 1 month after resection. Diagnostic and therapeutic strategies were evaluated. Two types of postoperative cholangitis were distinguished; obstructive cholangitis (benign stenosis of the hepaticojejunostomy) and nonobstructive cholangitis. Potential risk factors were identified using logistic regression analysis.RESULTS: Postoperative cholangitis occurred in 93 of 900 patients (10.3%). Median time to first episode of cholangitis was 8 months (interquartile range 4-16) after pancreatoduodenectomy. Multiple episodes of cholangitis occurred in 44 patients (47.3%) and readmission was necessary in 83 patients (89.2%). No cholangitis-related mortality was observed. Obstructive cholangitis was seen in 37 patients (39.8%) and nonobstructive cholangitis in 56 patients (60.2%). Surgery was performed for cholangitis in 7 patients (7.5%) and consisted of revision of the hepaticojejunostomy or elongation of the biliary limb. Postoperative biliary leakage (odds ratio 2.56; 95% confidence interval 1.42-4.62; P = .0018) was independently associated with postoperative cholangitis.CONCLUSION: Postoperative cholangitis unrelated to cancer recurrence was seen in 10% of patients after pancreatoduodenectomy. Nonobstructive cholangitis was more common than obstructive cholangitis. Postoperative biliary leakage was an independent risk factor.

AB - BACKGROUND: Postoperative cholangitis is a common complication after pancreatoduodenectomy that can occur with or without anatomical biliary obstruction. This study aimed to investigate the incidence, diagnosis, treatment, and risk factors of cholangitis after pancreatoduodenectomy.METHODS: We performed a retrospective cohort study of consecutive patients who underwent pancreatoduodenectomy in 2 Dutch tertiary pancreatic centers (2010-2019). Primary outcome was postoperative cholangitis, defined as systemic inflammation with abnormal liver tests without another focus of infection, at least 1 month after resection. Diagnostic and therapeutic strategies were evaluated. Two types of postoperative cholangitis were distinguished; obstructive cholangitis (benign stenosis of the hepaticojejunostomy) and nonobstructive cholangitis. Potential risk factors were identified using logistic regression analysis.RESULTS: Postoperative cholangitis occurred in 93 of 900 patients (10.3%). Median time to first episode of cholangitis was 8 months (interquartile range 4-16) after pancreatoduodenectomy. Multiple episodes of cholangitis occurred in 44 patients (47.3%) and readmission was necessary in 83 patients (89.2%). No cholangitis-related mortality was observed. Obstructive cholangitis was seen in 37 patients (39.8%) and nonobstructive cholangitis in 56 patients (60.2%). Surgery was performed for cholangitis in 7 patients (7.5%) and consisted of revision of the hepaticojejunostomy or elongation of the biliary limb. Postoperative biliary leakage (odds ratio 2.56; 95% confidence interval 1.42-4.62; P = .0018) was independently associated with postoperative cholangitis.CONCLUSION: Postoperative cholangitis unrelated to cancer recurrence was seen in 10% of patients after pancreatoduodenectomy. Nonobstructive cholangitis was more common than obstructive cholangitis. Postoperative biliary leakage was an independent risk factor.

UR - http://www.scopus.com/inward/record.url?scp=85199461866&partnerID=8YFLogxK

U2 - 10.1016/j.surg.2024.06.044

DO - 10.1016/j.surg.2024.06.044

M3 - Article

C2 - 39054185

SN - 0039-6060

VL - 176

SP - 1207

EP - 1214

JO - Surgery

JF - Surgery

IS - 4

ER -

Late cholangitis after pancreatoduodenectomy: A common complication with or without anatomical biliary obstruction

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