Pyogenic Liver Abscess Following Pancreaticoduodenectomy

Risk Factors, Treatment, and Long-Term Outcome

Victor C. Njoku, Thomas Howard, Changyu Shen, Nicholas Zyromski, C. Schmidt, Henry A. Pitt, Attila Nakeeb, Keith D. Lillemoe

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background: Pancreaticoduodenectomy (PD) remains a challenging operation with a 40 % postoperative complication rate. Pyogenic liver abscess (PLA) is an uncommon complication following PD with little information on its incidence or treatment. This study was done to examine the incidence, risk factors, treatment, and long-term outcome of PLA after PD. Methods: We retrospectively reviewed 1,189 patients undergoing PD (N = 839) or distal pancreatectomy (DP) (N = 350) at a single institution over a 14-year period (January 1, 1994-January 1, 2008). Pancreatic databases (PD and DP) were queried for postoperative complications and cross-checked through a hospital-wide database using ICD-9 codes 572.0 (PLA) and 006.3 (amebic liver abscess) as primary or secondary diagnoses. No PLA occurred following DP. Twenty-two patients (2.6 %) developed PLA following PD. These 22 patients were matched (1:3) for age, gender, year of operation, and indication for surgery with 66 patients without PLA following PD. Results: PLA occurred in 2.6 % (22/839) of patients following PD, with 13 patients (59.1 %) having a solitary abscess and 9 (40.9 %) multiple abscesses. Treatment involved antibiotics and percutaneous drainage (N = 15, 68.2 %) or antibiotics alone (N = 7, 31.8 %) with a mean hospital stay of 12 days. No patient required surgical drainage, two abscesses recurred, and all subsequently resolved. Three patients (14 %) died related to PLA. Postoperatively, patients with biliary fistula (13.6 vs. 0 %, p = 0.014) or who required reoperation (18.2 vs. 1.5 %, p = 0.013) had a significantly higher rate of PLA than matched controls. Long-term follow-up showed equivalent 1-year (79 vs.74 %), 2-year (50 vs. 57 %), and 3-year (38 vs. 33 %) survival rates and hepatic function between patients with PLA and matched controls. Conclusions: Postoperative biliary fistula and need for reoperation are risk factors for PLA following PD. Antibiotics and selective percutaneous drainage was effective in 86 % of patients with no adverse effects on long-term hepatic function or survival.

Original languageEnglish
Pages (from-to)922-928
Number of pages7
JournalJournal of Gastrointestinal Surgery
Volume18
Issue number5
DOIs
StatePublished - 2014

Fingerprint

Pyogenic Liver Abscess
Pancreaticoduodenectomy
Pancreatectomy
Therapeutics
Abscess
Biliary Fistula
Drainage
International Classification of Diseases
Anti-Bacterial Agents
Reoperation
Databases
Amoebic Liver Abscess
Liver
Incidence
Length of Stay

Keywords

  • Complications
  • Pancreas
  • Pancreaticoduodenectomy
  • Pyogenic liver abscess
  • Surgery

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology
  • Medicine(all)

Cite this

Pyogenic Liver Abscess Following Pancreaticoduodenectomy : Risk Factors, Treatment, and Long-Term Outcome. / Njoku, Victor C.; Howard, Thomas; Shen, Changyu; Zyromski, Nicholas; Schmidt, C.; Pitt, Henry A.; Nakeeb, Attila; Lillemoe, Keith D.

In: Journal of Gastrointestinal Surgery, Vol. 18, No. 5, 2014, p. 922-928.

Research output: Contribution to journalArticle

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abstract = "Background: Pancreaticoduodenectomy (PD) remains a challenging operation with a 40 {\%} postoperative complication rate. Pyogenic liver abscess (PLA) is an uncommon complication following PD with little information on its incidence or treatment. This study was done to examine the incidence, risk factors, treatment, and long-term outcome of PLA after PD. Methods: We retrospectively reviewed 1,189 patients undergoing PD (N = 839) or distal pancreatectomy (DP) (N = 350) at a single institution over a 14-year period (January 1, 1994-January 1, 2008). Pancreatic databases (PD and DP) were queried for postoperative complications and cross-checked through a hospital-wide database using ICD-9 codes 572.0 (PLA) and 006.3 (amebic liver abscess) as primary or secondary diagnoses. No PLA occurred following DP. Twenty-two patients (2.6 {\%}) developed PLA following PD. These 22 patients were matched (1:3) for age, gender, year of operation, and indication for surgery with 66 patients without PLA following PD. Results: PLA occurred in 2.6 {\%} (22/839) of patients following PD, with 13 patients (59.1 {\%}) having a solitary abscess and 9 (40.9 {\%}) multiple abscesses. Treatment involved antibiotics and percutaneous drainage (N = 15, 68.2 {\%}) or antibiotics alone (N = 7, 31.8 {\%}) with a mean hospital stay of 12 days. No patient required surgical drainage, two abscesses recurred, and all subsequently resolved. Three patients (14 {\%}) died related to PLA. Postoperatively, patients with biliary fistula (13.6 vs. 0 {\%}, p = 0.014) or who required reoperation (18.2 vs. 1.5 {\%}, p = 0.013) had a significantly higher rate of PLA than matched controls. Long-term follow-up showed equivalent 1-year (79 vs.74 {\%}), 2-year (50 vs. 57 {\%}), and 3-year (38 vs. 33 {\%}) survival rates and hepatic function between patients with PLA and matched controls. Conclusions: Postoperative biliary fistula and need for reoperation are risk factors for PLA following PD. Antibiotics and selective percutaneous drainage was effective in 86 {\%} of patients with no adverse effects on long-term hepatic function or survival.",
keywords = "Complications, Pancreas, Pancreaticoduodenectomy, Pyogenic liver abscess, Surgery",
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T1 - Pyogenic Liver Abscess Following Pancreaticoduodenectomy

T2 - Risk Factors, Treatment, and Long-Term Outcome

AU - Njoku, Victor C.

AU - Howard, Thomas

AU - Shen, Changyu

AU - Zyromski, Nicholas

AU - Schmidt, C.

AU - Pitt, Henry A.

AU - Nakeeb, Attila

AU - Lillemoe, Keith D.

PY - 2014

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N2 - Background: Pancreaticoduodenectomy (PD) remains a challenging operation with a 40 % postoperative complication rate. Pyogenic liver abscess (PLA) is an uncommon complication following PD with little information on its incidence or treatment. This study was done to examine the incidence, risk factors, treatment, and long-term outcome of PLA after PD. Methods: We retrospectively reviewed 1,189 patients undergoing PD (N = 839) or distal pancreatectomy (DP) (N = 350) at a single institution over a 14-year period (January 1, 1994-January 1, 2008). Pancreatic databases (PD and DP) were queried for postoperative complications and cross-checked through a hospital-wide database using ICD-9 codes 572.0 (PLA) and 006.3 (amebic liver abscess) as primary or secondary diagnoses. No PLA occurred following DP. Twenty-two patients (2.6 %) developed PLA following PD. These 22 patients were matched (1:3) for age, gender, year of operation, and indication for surgery with 66 patients without PLA following PD. Results: PLA occurred in 2.6 % (22/839) of patients following PD, with 13 patients (59.1 %) having a solitary abscess and 9 (40.9 %) multiple abscesses. Treatment involved antibiotics and percutaneous drainage (N = 15, 68.2 %) or antibiotics alone (N = 7, 31.8 %) with a mean hospital stay of 12 days. No patient required surgical drainage, two abscesses recurred, and all subsequently resolved. Three patients (14 %) died related to PLA. Postoperatively, patients with biliary fistula (13.6 vs. 0 %, p = 0.014) or who required reoperation (18.2 vs. 1.5 %, p = 0.013) had a significantly higher rate of PLA than matched controls. Long-term follow-up showed equivalent 1-year (79 vs.74 %), 2-year (50 vs. 57 %), and 3-year (38 vs. 33 %) survival rates and hepatic function between patients with PLA and matched controls. Conclusions: Postoperative biliary fistula and need for reoperation are risk factors for PLA following PD. Antibiotics and selective percutaneous drainage was effective in 86 % of patients with no adverse effects on long-term hepatic function or survival.

AB - Background: Pancreaticoduodenectomy (PD) remains a challenging operation with a 40 % postoperative complication rate. Pyogenic liver abscess (PLA) is an uncommon complication following PD with little information on its incidence or treatment. This study was done to examine the incidence, risk factors, treatment, and long-term outcome of PLA after PD. Methods: We retrospectively reviewed 1,189 patients undergoing PD (N = 839) or distal pancreatectomy (DP) (N = 350) at a single institution over a 14-year period (January 1, 1994-January 1, 2008). Pancreatic databases (PD and DP) were queried for postoperative complications and cross-checked through a hospital-wide database using ICD-9 codes 572.0 (PLA) and 006.3 (amebic liver abscess) as primary or secondary diagnoses. No PLA occurred following DP. Twenty-two patients (2.6 %) developed PLA following PD. These 22 patients were matched (1:3) for age, gender, year of operation, and indication for surgery with 66 patients without PLA following PD. Results: PLA occurred in 2.6 % (22/839) of patients following PD, with 13 patients (59.1 %) having a solitary abscess and 9 (40.9 %) multiple abscesses. Treatment involved antibiotics and percutaneous drainage (N = 15, 68.2 %) or antibiotics alone (N = 7, 31.8 %) with a mean hospital stay of 12 days. No patient required surgical drainage, two abscesses recurred, and all subsequently resolved. Three patients (14 %) died related to PLA. Postoperatively, patients with biliary fistula (13.6 vs. 0 %, p = 0.014) or who required reoperation (18.2 vs. 1.5 %, p = 0.013) had a significantly higher rate of PLA than matched controls. Long-term follow-up showed equivalent 1-year (79 vs.74 %), 2-year (50 vs. 57 %), and 3-year (38 vs. 33 %) survival rates and hepatic function between patients with PLA and matched controls. Conclusions: Postoperative biliary fistula and need for reoperation are risk factors for PLA following PD. Antibiotics and selective percutaneous drainage was effective in 86 % of patients with no adverse effects on long-term hepatic function or survival.

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