Open AccessDual‐center randomized clinical trial exploring the optimal duration of antimicrobial prophylaxis in patients undergoing pancreaticoduodenectomy following biliary drainage
Author(s) -
Yamamoto Tomohisa,
Satoi Sohei,
Fujii Tsutomu,
Yamada Suguru,
Yanagimoto Hiroaki,
Yamaki So,
Takami Hideki,
Hirooka Satoshi,
Kosaka Hisashi,
Kotsuka Masaya,
Miyara Takayuki,
Kodera Yasuhiro
Publication year - 2018
Publication title -
annals of gastroenterological surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.308
H-Index - 15
ISSN - 2475-0328
DOI - 10.1002/ags3.12209
Subject(s) - pancreaticoduodenectomy , medicine , biliary drainage , biliary stent , antimicrobial , randomized controlled trial , dual (grammatical number) , center (category theory) , gastroenterology , surgery , general surgery , stent , microbiology and biotechnology , pancreas , biology , chemistry , art , literature , crystallography
Objectives The aim of this dual‐center randomized controlled trial was to determine the optimal duration of antimicrobial prophylaxis in patients treated with pancreaticoduodenectomy ( PD ) who underwent preoperative biliary drainage ( PBD ) but were without cholangitis. Background Some reports showed that PBD in patients undergoing pancreatectomy increased the rate of perioperative complications. However, no clinical trial has evaluated the optimal duration of antimicrobial prophylaxis with a focus on patients who underwent PD following PBD . Methods A total of 82 patients who underwent PD between March 2012 and December 2016 were randomly assigned to either a 1‐day group (n = 40), in which cefozopran ( CZOP ) as antimicrobial prophylaxis was given only on the day of surgery, or a 5‐day group (n = 42), in which CZOP was given for 5 consecutive days beginning on the day of surgery. We evaluated the incidence of infectious and other complications after PD . Results Outcomes were significantly better in the 1‐day group compared with the 5‐day group ( P < 0.05) in terms of the incidence of overall infectious complications (15% vs 36%, respectively), intra‐abdominal abscess (3% vs 21%, respectively), clinically relevant postoperative pancreatic fistula (8% vs 24%, respectively), and Clavien‐Dindo grade III ‐V complications (10% vs 31%, respectively). Duration of postoperative hospital stay was significantly shorter in the 1‐day group (10 days vs 15 days, P = 0.018). Anaerobic bacteria and methicillin‐resistant cocci were isolated from the drainage fluid only among patients in the 5‐day group. Conclusion Single‐day prophylactic use of CZOP is appropriate for patients who undergo PD following PBD without preoperative cholangitis.