Abstract
BackgroundBecause the survival rate for patients experiencing late complications after pancreaticoduodenectomy (PD) is increasing, late complications should receive as much attention as early complications do.MethodsBetween April 2007 and August 2016, 133 patients underwent PD at our institution. We analyzed their cases to determine the predictors of late cholangitis after PD.ResultsOf the 133 patients, 28 (21.1%) were diagnosed with postoperative cholangitis. A multivariate analysis showed that abnormal postoperative values of alkaline phosphatase were independently associated with postoperative cholangitis (odds ratio, 3.81; 95% confidence interval, 1.519–9.553; P = 0.004). The optimal cut-off value for postoperative alkaline phosphatase calculated from the receiver operating characteristic curve was 410 IU/L (sensitivity, 76.2%; specificity, 67.9%; area under the curve, 0.73). A univariate analysis to identify risk factors showed that pneumobilia was significantly related to a postoperative alkaline phosphatase value ≥ 410 IU/L (P = 0.041).ConclusionThis study suggests that an alkaline phosphatase level ≥ 410 IU/L is a predictor of late postoperative cholangitis. In addition, pneumobilia is also related to the postoperative alkaline phosphatase level. Therefore, alkaline phosphatase levels should be carefully monitored in patients with postoperative pneumobilia in the late postoperative course.
Highlights
Because the survival rate for patients experiencing late complications after pancreaticoduodenectomy (PD) is increasing, late complications should receive as much attention as early complications do
These results are slightly lower than our result that 28 (21.1%) of 133 patients were diagnosed with postoperative cholangitis
We focused on the impact of the alkaline phosphatase cut-off value demonstrated by the receiver operating characteristic (ROC) curve, which we expect to be a predictor of postoperative cholangitis
Summary
Because the survival rate for patients experiencing late complications after pancreaticoduodenectomy (PD) is increasing, late complications should receive as much attention as early complications do. The survival rate for patients undergoing pancreaticoduodenectomy (PD) for peripancreatic carcinoma is increasing due to improvements in operative techniques, perioperative management, and early detection. Late complications after PD should receive as much attention as early complications do. Reported early complications after PD include pancreatic fistula, delayed gastric emptying, infectious complications, and biliary complications [1, 2]. Several studies focused on late complications after PD have been reported. Very few have focused on late biliary complications, especially postoperative cholangitis. Most patients with late postoperative cholangitis are managed with conservative therapy.
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