Harnoss Julian C, Halm Darius, Weber Sophie, Kinny-Köster Benedict, Heckler Max, Klotz Rosa, Kalkum Eva, Harnoss Jonathan M, Musa Julian, Probst Pascal, Michalski Christoph W, Loos Martin, Hank Thomas
Department of General, Visceral and Transplant Surgery, Heidelberg University Hospital, Heidelberg, Germany.
SDGC, The Study Center of the German Surgical Society, University of Heidelberg, Heidelberg, Germany.
Ann Surg. 2025 Mar 21. doi: 10.1097/SLA.0000000000006703.
This review evaluated whether broad-spectrum penicillin-based antibiotic prophylaxis (BS-AB) such as piperacillin-tazobactam might lead to better outcomes in pancreatoduodenectomy compared to standard care antibiotics, mainly cephalosporins (CE-AB).
Pancreatoduodenectomy is commonly associated with high postoperative infectious complications contributing to increased morbidity, mortality and healthcare costs.
A systemic literature search (PubMed, EMBASE, Cochrane Library and Web of Science) was conducted to identify suitable RCTs and non-RCTs. After inclusion, the data were analyzed using a random-effects model with the Mantel-Haenszel model or inverse variance to calculate, odds ratio (OR) or mean difference (MD) with 95% confidence intervals (CI).
One RCT and 11 non-RCTs were included with 12,469 patients (35,3% BS-AB, 64,7% CE-AB). Surgical site infections (SSI) were significantly lower after BS-AB when compared to CE-AB, (OR 0.53; CI [0.32-0.86]; P =0.01; I 2 =79%) as well as the occurrence of postoperative pancreatic fistula (POPF) (OR 0.62; CI [0.47-0.81]; P <0.01; I 2 =0%), days of hospitalization (MD-2.02; CI [-4.08-0.03]; P =0.05; I 2 =98%) and mortality (OR 0.56; CI [0.34-0.95]; P =0.03; I 2 =0%). Subgroup analyses of patients with preoperative biliary drainage demonstrated an even higher effect of BS-AB in reducing SSI (OR 0.45, CI [0.45-0.67]; P =0.01; I 2 =78%), POPF (OR 0.52; CI [0.36-0.75]; P <0.01; I 2 =0%) and mortality (OR 0.34; CI [0.15-0.76]; P <0.01; I 2 =0%).
BS-AB significantly reduces the risk of infectious complications and surgical outcomes in pancreatoduodenectomy compared to CE-AB, particularly in patients with preoperative biliary drainage. These findings support the use of BS-AB as a new gold standard for patients undergoing pancreatoduodenectomy.
