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Updated: Sep 22, 2025
Complete Laparoscopic Radical Resection of Perihilar Cholangiocarcinoma Type IIIb
Published on: January 17, 2025
Infectious complications after surgery for perihilar cholangiocarcinoma: A single Western center experience
Andrea Ruzzenente1, Laura Alaimo1, Marco Caputo1
1Department of Surgery, Dentistry, Gynecology, and Pediatrics, Division of General and Hepato-Biliary Surgery, University of Verona, Italy.
Background:
The aim of this study was to analyze the risk factors for surgical infectious complications and the outcomes of patients undergoing surgery for perihilar cholangiocarcinoma according to the microbiological examinations.
Methods:
Patients who underwent surgery for perihilar cholangiocarcinoma in the last decade were enrolled, and all clinical and microbiological data were collected from a retrospective monocentric database. Univariate and multivariate analyses were performed distinguishing patients who developed at least 1 surgical infectious complication (surgical site infections, acute bacterial cholangitis, bacteremia).
Results:
A total of 98 patients were included. Among patients who developed surgical infectious complications (51%), many preoperative characteristics were significantly more frequent: American Society of Anesthesiologists score ≥3 (P = .026), neutrophil-to-lymphocyte ratio ≥3.4 (P = .001), endoscopic sphincterotomy (P = .032), ≥2 biliary drainage procedures (P = .013), acute cholangitis (P = .012), multidrug resistant (P = .009), and ≥3 microorganisms' detection (P = .042); whereas during the postoperative period, surgical infectious complications were associated to increased incidence of intensive care unit readmission (P = .031), major complications (P < .001), posthepatectomy liver failure (P = .005), ascites (P = .008), biliary leakage (P = .008), 90-day readmission (P = .003), and prolonged length of hospital stay (P < .001). At the multivariate analysis 3 independent preoperative risk factors for surgical infectious complications were identified: neutrophil-to-lymphocyte ratio ≥3.4 (P = .004), endoscopic sphincterotomy (P = .009), and acute cholangitis (P = .013). The presence of multidrug-resistance in the perioperative biliary cultures was related to postoperative multidrug-resistant species from all cultures (P < .001) and organ/space and incisional-surgical site infections (P ≤ .044).
Conclusion:
Infective complications after surgery for perihilar cholangiocarcinoma worsen the short-term outcomes. A careful microbiological surveillance should be carried out in all cases to prevent and promptly treat surgical infectious complications.
Insights
Surgical infectious complications significantly worsen outcomes for perihilar cholangiocarcinoma patients. Preoperative factors like high neutrophil-to-lymphocyte ratio and acute cholangitis are key risk factors, necessitating microbiological surveillance.
Area of Science:
- Hepatobiliary Surgery
- Surgical Oncology
- Infectious Disease Epidemiology
Background:
- Perihilar cholangiocarcinoma surgery carries a high risk of infectious complications.
- Understanding these complications is crucial for improving patient outcomes.
Purpose of the Study:
- To identify preoperative and postoperative risk factors for surgical infectious complications in perihilar cholangiocarcinoma patients.
- To analyze the impact of these complications on patient outcomes.
- To correlate microbiological findings with infection types and severity.
Main Methods:
- Retrospective analysis of 98 patients undergoing perihilar cholangiocarcinoma surgery.
- Collection of clinical and microbiological data.
- Univariate and multivariate analyses to identify risk factors and outcomes.
Main Results:
- 51% of patients developed surgical infectious complications.
- Independent preoperative risk factors identified: high neutrophil-to-lymphocyte ratio, endoscopic sphincterotomy, and acute cholangitis.
- Complications were associated with increased ICU readmission, major complications, liver failure, and prolonged hospital stay.
- Multidrug-resistant organisms in biliary cultures correlated with specific postoperative infections.
Conclusions:
- Infective complications significantly impair short-term outcomes after perihilar cholangiocarcinoma surgery.
- Proactive microbiological surveillance is essential for preventing and managing these complications.
