Cephalic duodenopancreatectomy is part of the curative treatment for pancreatic cancer of the head and peri-ampullary area. The mortality of the procedure is around 5%, with a morbidity ranging from 30 to 50%. Infectious complications account for 35% of overall morbidity. One of the risk factors for postoperative complications is the existence of preoperative retentional jaundice, due to tumoral obstruction of the main bile duct In these cases, it is proposed to perform preoperative bile duct drainage, preferably by endoscopic stenting (ERCP). However, several studies have shown these procedures to cause biliary contamination which could be responsible for an increase in post-operative morbidity such as infectious complications and increased length of stay in hospital.. Thus, the biliary microbial flora is more often multi-microbial and may contain multidrug-resistant nosocomial germs, The study carried out by Cortes et al., based on a control case study design, also showed that a correlation between biliary colonization and postoperative infectious complications existed in patients who benefited from a preoperative biliary drainage technique. In fact, the bacteria isolated during intraoperative bile sampling were similar, in 49% of cases, to those isolated during bacteriological samples collected postoperatively during infectious complications. The work carried out by Krüger and al has shown that the spectrum of bacteria found in the preoperative bile samples from patients who have undergone bile duct dilation is potentially not covered by standard antibiotic therapy. The aim of this observational prospective study is to investigate this correlation between biliary colonization and postoperative infectious complications, to evaluate the morbidity and postoperative mortality of cephalic duodenopancreatectomies performed at the CHRU of Nancy and to study a possible adaptation of perioperative antibiotic prophylaxis.
Study Type
OBSERVATIONAL
Enrollment
70
Chru Nancy
Vandœuvre-lès-Nancy, France
Comparison of preoperative Bile and postoperative infection sites microbiology results
bacterial count in log10 bacteria/ml and identification
Time frame: from date of initial bile sample up to 30 days of postoperative period
Impact of prior biliary drainage on the intraoperative bile microbiological results bacteriological results obtained
bacterial count in log10 bacteria/ml and species identification
Time frame: from date of initial bile sampling to date of surgery (up to 90 days)
Microbial flora in clinical specimens obtained from different sites
bacterial count in log10 bacteria/ml and species identification
Time frame: from date of initial bile sample up to 90 postoperative days
Non infectious surgical complications using scores
Clavien-Dindo Classification, SOFA score
Time frame: from date of surgery up to 30 postoperative days
postoperative infectious complications as defined by the Centers for Disease Control and Prevention (Atlanta, Ga)
number of event occurence
Time frame: During hospital stay (up to 90 days after surgery)
Implication of bacteria found in biliculture as causative agent in post-operative infections
incidence in percentage
Time frame: During hospital stay (up to 90 days after surg
length of stay in intensive care and hospital
Number of days in ICU and hospital
Time frame: During the ICU stay and hospital
mortality rate
number of death at 28 days and 90 days
Time frame: At day +28 and day +90
Description of nutrition assistance
Parenteral, enteral, oral feeding in days and calories
Time frame: from date of initial bile sample up to 30 days of postoperative period
Nutritional status measured by nutritional risk index (NRI)
Body mass index (BMI) and albuminemia computation
Time frame: preoperative
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