Abstract
Simple SummaryBiliary drainage leads to bacterial biliary contamination, but there are few studies on the impact of fungal biliary contamination after pancreaticoduodenectomy (PD). This retrospective multicenter study identified two groups: bacterial contamination only (B+, n = 154; 75%), and bacterial and fungal contamination (BF+, n = 52; 25%). An extended duration of preoperative drainage (62 vs. 49 days; p = 0.08) increased the risk of fungal contamination, but there were no differences between the two groups in relation to specific or infectious postoperative complications. According to this study, there is no argument to recommend the use of anti-fungal treatment as a prophylactic treatment during PD preceded by biliary drainage.(1) Background: preoperative biliary drainage before pancreaticoduodenectomy (PD) is associated with bacterial biliary contamination (>85%) and a significant increase in global and infectious complications. In view of the lack of published data, the aim of our study was to investigate the impact of fungal biliary contamination after biliary drainage on the complication rate after PD. (2) Methods: a multicentric retrospective study that included 224 patients who underwent PD after biliary drainage with intraoperative biliary culture. (3) Results: the global rate of positive intraoperative biliary sample was 92%. Respectively, the global rate of biliary bacterial contamination and the rate of fungal contamination were 75% and 25%, making it possible to identify two subgroups: bacterial contamination only (B+, n = 154), and bacterial and fungal contamination (BF+, n = 52). An extended duration of preoperative drainage (62 vs. 49 days; p = 0.08) increased the risk of fungal contamination. The overall and infectious complication rates were not different between the two groups. In the event of postoperative infectious or surgical complications, the infectious samples taken did not reveal more fungal infections in the BF+ group. (4) Conclusions: fungal biliary contamination, although frequent, does not seem to increase the rate of global and infectious complications after PD, preceded by preoperative biliary drainage.
Highlights
Pancreaticoduodenectomy (PD) remains as the only curative treatment for the biliopancreatic crossroads tumors
The only difference observed between the two groups regarding intraoperative data, is that more resection of other organs were done in the BF group (n = 7; 13%) than in the B group (n = 5; 3%) (p = 0.02)
We found that in the BF group, only one patient had a fungemia involved Candida albicans, which was the same germ as in the intraoperative biliary sampling
Summary
Pancreaticoduodenectomy (PD) remains as the only curative treatment for the biliopancreatic crossroads tumors. Mortality rate after PD is high, between 8.2% and 11.1%, according to recent data from health registers [1,2]. Multi-visceral failure from infectious complications (45%) is the leading cause of death at 90 days after PD [4]. They will have oncological impact, delaying the start of adjuvant treatment and doubling the risk of not receiving it [5,6,7]. There are two types of infectious complications, surgical site infections (SSI), as defined by the Center for Disease Control [8,9], and general infectious complications, such as urinary, respiratory, and vascular access infections.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
