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Failure of peritoneal lavage to prevent operative site infection and peritoneal tumor recurrence in pancreatic surgery

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Abstract

Background

Although intraoperative peritoneal lavage often is performed routinely with the aim of reducing peritoneal contamination, evidence of lavage benefit in elective pancreatic surgery is limited.

Methods

We retrospectively classified patients who had undergone pancreatic surgery to groups given or not given peritoneal lavage, then comparing clinical results. This saline lavage was performed at the end of the operation. The primary endpoint was rate of surgical site infection. Frequency of peritoneal recurrence also was evaluated.

Results

Among all 104 patients in the study, incidence of infectious complications in the lavage group (n = 65) was significantly higher than in the non-lavage group (n = 39; 35% vs. 15%, P = 0.041), while incidences of postoperative complications overall and surgical site infection did not differ between lavage (80% and 26%) and non-lavage groups (67% and 10%, P = 0.162 and 0.076, respectively). Among 63 patients undergoing pancratoduodenectomy, frequencies of positive bacterial cultures of drainage fluids on postoperative days 1 and 3 were greater in the non-lavage group (P < 0.001 and P = 0.012), but surgical site infection was significantly more frequent in the lavage group (P = 0.043). Among patients with pancreatic and biliary cancers, lavage did not affect frequency of peritoneal recurrence.

Conclusion

Intraoperative lavage did not prevent surgical site infection or peritoneal recurrence of pancreatobiliary cancer.

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Abbreviations

BMI:

Body mass index

CI:

Confidence interval

CT:

Computed tomography

CTx:

Chemotherapy

DP:

Distal pancreatectomy

Hb:

Hemoglobin

ISGPF:

International Study Group on Pancreatic Fistula Definition

PD:

Pancreatoduodenectomy

PNI:

Prognostic nutritional index

POD:

Postoperative day

POPF:

Postoperative pancreatic fistula

PV:

Portal vein

R:

Resection

RAMPS:

Radical antegrade modular pancreato-splenectomy

RFS:

Recurrence-free survival

SMA:

Superior mesenteric artery

SMV:

Superior mesenteric vein

SSI:

Surgical site infections

TP:

Total pancreatectomy

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Author information

Authors and Affiliations

  1. General and Gastroenterological Surgery, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, Kanagawa, 227-8501, Japan

    Mai Ishihara, Akihiro Nakamura, Yuki Takahashi, Yuzo Minegishi, Kenichi Matsuo & Kuniya Tanaka

Authors
  1. Mai Ishihara
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  2. Akihiro Nakamura
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  3. Yuki Takahashi
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  4. Yuzo Minegishi
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  5. Kenichi Matsuo
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  6. Kuniya Tanaka
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Contributions

Study conception and design, Dr. Tanaka; acquisition of data, Drs. Ishihara, Takahashi, Minegishi, and Nakamura; analysis and interpretation of data, Drs. Ishihara, Takahashi, and Nakamura; drafting the article, Drs. Ishihara and Tanaka; revising the article, Drs. Matsuo and Tanaka; final approval, Dr. Tanaka.

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Correspondence to Kuniya Tanaka.

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Ishihara, M., Nakamura, A., Takahashi, Y. et al. Failure of peritoneal lavage to prevent operative site infection and peritoneal tumor recurrence in pancreatic surgery. Langenbecks Arch Surg 408, 333 (2023). https://doi.org/10.1007/s00423-023-03080-3

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