Pancreatic juice leakage is a risk factor for deep mycosis after pancreatic surgery View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2009-03-25

AUTHORS

Yukihiro Iso, Tokihiko Sawada, Nobumi Tagaya, Masato Kato, Kyu Rokkaku, Mitsugi Shimoda, Junji Kita, Keiichi Kubota

ABSTRACT

PurposeDeep mycosis (DM) is an opportunistic infection that can be fatal in immunocompromised hosts. Pancreatic surgery is associated with a high degree of stress and patients who undergo pancreatic surgery are considered to be immunocompromised. This study retrospectively evaluated whether DM affects the clinical course after pancreatic surgery.MethodsBetween January 2005 and April 2007, 67 patients underwent pancreatic surgery. There were 42 males (62.7%) and 25 females (37.3%) with a mean age of 66.7 years. Their diagnoses consisted of cancer of the papilla of Vater (n = 9), pancreatic head cancer (n = 20), pancreatic tail cancer (n = 3), bile duct cancer (n = 17), duodenal cancer (n = 3), and others (n = 15). Surgical procedures included pancreatoduodenectomies (PD; n = 52), hepato-pancreatoduodenectomies (HPD; n = 4), distal pancreatectomies (DP; n = 7), total pancreatectomies (TP; n = 2), and the modified Puestow procedure (m-Pp; n = 2). Patients who were positive for any of CAND-TEC (C-T), β-d-glucan (β-d), or culture for mycosis were classified into group 1 (G1; n = 12) and those who were negative for all these examinations were classified into group 2 (G2; n = 55). The preoperative, perioperative, and postoperative data were compared between G1 and G2. An antifungal drug (Micafungin; 75 mg per day) was given to G1 patients.ResultsThe preoperative data included the neutrophil and lymphocyte counts, total protein, blood urea nitrogen, and amylase, and there were no significant differences in these parameters between the two groups. However, the incidences of diabetes mellitus and total bilirubin at maximum in G1 and G2 were 41.7% and 7.3% (P = 0.04), 4.6 ± 1.5 and 1.4 ± 0.9 (P = 0.007), respectively. The mean operation time in G1 and G2 was 548.5 ± 138.1 and 510.0 ± 133.7 min (P = 0.39) and intraoperative blood loss was 762.2 ± 369.5 and 782.5 ± 599.1 ml (P = 0.88), respectively. The postoperative complications included pneumonia (G1: G2 = 7: 20; P = 0.14), pleural effusion (7: 24; P = 0.27) and ascites (10: 33; P = 0.11), with no significant intergroup differences. However, the respective durations of pancreatic juice leakage in G1 and G2 were 12 and 12, respectively, with a statistically significant difference (P < 0.01). All the G1 patients were treated with the antifungal drug for 7.8 days. Postoperative hospital stays in G1 and G2 were 47.3 days and 38.7 days, respectively (P = 0.15) and the survival rates at 19 months after surgery were 46.7% and 79.4%, respectively (P = 0.04).ConclusionsDeep mycosis was observed in patients with pancreatic juice leakage, thus contributing to a poor outcome. Therefore, an early diagnosis of DM and the initiation of antifungal treatment are necessary for the improving prognosis. More... »

PAGES

326

References to SciGraph publications

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00595-008-3871-y

DOI

http://dx.doi.org/10.1007/s00595-008-3871-y

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1018905706

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/19319641


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26 schema:description PurposeDeep mycosis (DM) is an opportunistic infection that can be fatal in immunocompromised hosts. Pancreatic surgery is associated with a high degree of stress and patients who undergo pancreatic surgery are considered to be immunocompromised. This study retrospectively evaluated whether DM affects the clinical course after pancreatic surgery.MethodsBetween January 2005 and April 2007, 67 patients underwent pancreatic surgery. There were 42 males (62.7%) and 25 females (37.3%) with a mean age of 66.7 years. Their diagnoses consisted of cancer of the papilla of Vater (n = 9), pancreatic head cancer (n = 20), pancreatic tail cancer (n = 3), bile duct cancer (n = 17), duodenal cancer (n = 3), and others (n = 15). Surgical procedures included pancreatoduodenectomies (PD; n = 52), hepato-pancreatoduodenectomies (HPD; n = 4), distal pancreatectomies (DP; n = 7), total pancreatectomies (TP; n = 2), and the modified Puestow procedure (m-Pp; n = 2). Patients who were positive for any of CAND-TEC (C-T), β-d-glucan (β-d), or culture for mycosis were classified into group 1 (G1; n = 12) and those who were negative for all these examinations were classified into group 2 (G2; n = 55). The preoperative, perioperative, and postoperative data were compared between G1 and G2. An antifungal drug (Micafungin; 75 mg per day) was given to G1 patients.ResultsThe preoperative data included the neutrophil and lymphocyte counts, total protein, blood urea nitrogen, and amylase, and there were no significant differences in these parameters between the two groups. However, the incidences of diabetes mellitus and total bilirubin at maximum in G1 and G2 were 41.7% and 7.3% (P = 0.04), 4.6 ± 1.5 and 1.4 ± 0.9 (P = 0.007), respectively. The mean operation time in G1 and G2 was 548.5 ± 138.1 and 510.0 ± 133.7 min (P = 0.39) and intraoperative blood loss was 762.2 ± 369.5 and 782.5 ± 599.1 ml (P = 0.88), respectively. The postoperative complications included pneumonia (G1: G2 = 7: 20; P = 0.14), pleural effusion (7: 24; P = 0.27) and ascites (10: 33; P = 0.11), with no significant intergroup differences. However, the respective durations of pancreatic juice leakage in G1 and G2 were 12 and 12, respectively, with a statistically significant difference (P < 0.01). All the G1 patients were treated with the antifungal drug for 7.8 days. Postoperative hospital stays in G1 and G2 were 47.3 days and 38.7 days, respectively (P = 0.15) and the survival rates at 19 months after surgery were 46.7% and 79.4%, respectively (P = 0.04).ConclusionsDeep mycosis was observed in patients with pancreatic juice leakage, thus contributing to a poor outcome. Therefore, an early diagnosis of DM and the initiation of antifungal treatment are necessary for the improving prognosis.
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33 DM
34 G1
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38 Vater
39 age
40 amylase
41 antifungal drugs
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43 ascites
44 bilirubin
45 blood loss
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47 cancer
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49 complications
50 count
51 course
52 culture
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55 deep mycosis
56 degree
57 diabetes mellitus
58 diagnosis
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63 duodenal cancer
64 duration
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66 effusion
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90 mellitus
91 min
92 months
93 mycosis
94 nitrogen
95 operation time
96 opportunistic infections
97 outcomes
98 pancreatectomy
99 pancreatic head cancer
100 pancreatic juice leakage
101 pancreatic surgery
102 pancreatic tail cancer
103 pancreatoduodenectomy
104 papilla of Vater
105 papillae
106 parameters
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108 pleural effusion
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111 postoperative complications
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115 procedure
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117 protein
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119 respective durations
120 risk factors
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123 stress
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127 survival rate
128 tail cancer
129 time
130 total bilirubin
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