Influence of Cholangitis after Preoperative Endoscopic Biliary Drainage on Postoperative Pancreatic Fistula in Patients with Middle and Lower Malignant Biliary Strictures

Abstract

Background

Preoperative cholangitis after preoperative drainage has been reported to increase postoperative complications, particularly pancreatic fistula.

We therefore examined the effects of cholangitis after preoperative endoscopic biliary drainage (EBD) on postoperative pancreatic fistula in patients with middle and lower malignant biliary strictures.

Methods

The study group comprised 102 patients who underwent EBD among patients who underwent surgery.

Results

Of the 102 patients, 33 (32%) had postoperative pancreatic fistulas, and 56 (55%) had preoperative cholangitis after preoperative drainage. An analysis of risk factors for preoperative cholangitis showed that a total bilirubin level of 2.9 mg/dL or higher (hazard ratio [HR], 2.95; 95% confidence interval [CI], 1.223 to 7.130; P = 0.016) and a surgical waiting time of 29 days or longer (HR, 4.23; 95% CI, 1.681 to 10.637; P = 0.02) were independent risk factors for cholangitis. Patients with preoperative cholangitis had a significantly higher incidence of pancreatic fistula than did patients without preoperative cholangitis (78.8% vs. 21.2%; P = 0.001). Patients with biliary cancer had a significantly higher incidence of pancreatic fistula than did those with pancreatic cancer (72.7% vs. 27.2%; P = 0.005). Multivariate analysis showed that preoperative cholangitis (HR, 4.8; 95% CI, 1.785 to 12.992; P = 0.001) and biliary cancer (HR, 3.5; 95% CI, 1.335 to 8.942; P = 0.006) were significant independent risk factors for postoperative pancreatic fistula.

Conclusions

The prevention of preoperative cholangitis, a risk factor for postoperative pancreatic fistula, is likely to decrease the incidence of postoperative pancreatic fistula.

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