Significance of Self-Expandable Metallic Stent for Postoperative Intra-Abdominal Infection After Pancreatoduodenectomy in Patients With a Hard Pancreas.

BACKGROUND

Self-expandable metal stents (SEMS) are often used for preoperative biliary drainage in pancreatoduodenectomy (PD); however, their impact on postoperative intra-abdominal infection (POAI) remains unclear. This study aimed to evaluate the clinical significance of SEMS in relation to POAI.

METHODS

The data of 314 consecutive patients who underwent elective PD between January 2018 and May 2022 were retrospectively analyzed. Patients were categorized by biliary drainage method (NON: no preoperative biliary drainage, PS: plastic stent, or SEMS), and the associations with POAI were assessed. Bile and drainage fluid cultures were microbiologically examined.

RESULTS

Soft pancreatic texture and preoperative biliary drainage were independently associated with POAI. In the hard pancreas subgroup undergoing preoperative biliary drainage (n = 45), all POAI cases occurred despite low drain fluid amylase levels and the absence of clinically relevant postoperative pancreatic fistula (POPF). SEMS placement was the only significant risk factor for POAI (odds ratio 4.38 [1.21-18.73], p = 0.03). The concordance rate between organisms in bile and drainage fluid was 66.7% in the SEMS group, 52.2% in the PS group, and 7.2% in the NON group. In the SEMS group, E. cloacae, E. faecalis, and E. faecium were the most frequently isolated organisms (38.1%, 33.3%, and 19.0%, respectively).

CONCLUSION

SEMS placement was associated with an increased risk of POAI in patients with a hard pancreas, who are unlikely to develop POPF. Bile cultures may assist in predicting the causative organisms of POAI in patients who undergo preoperative biliary drainage.