Objective To analyze the incidence, clinical characteristics, risk factors, and treatment outcomes of pyogenic liver abscess (PLA) following pancreaticoduodenectomy (PD). Methods Data were collected from patients who underwent PD at the Pancreas Center of the Affiliated BenQ Hospital of Nanjing Medical University between October 20, 2020, and December 31, 2023. Patients who developed PLA postoperatively were identified, and their data were collected. Using propensity score matching (PSM), patients who developed PLA postoperatively were matched with those who did not, on the basis of age, sex, diagnosis, and year of surgery, at a 1:3 ratio. The characteristics and prognosis of patients with PLA following PD were analyzed, and the factors influencing the occurrence of PLA were evaluated. Results Among 355 patients who underwent PD, 19 (5.4%, 19/355) developed PLA, with an average onset time of 9.1 ± 2.0 months (range: 0.7–34 months). Most PLAs were single abscesses (78.9%, 15/19) predominantly located at the right lobe of the liver (63.2%, 12/19), with an average size of 4.8 ± 0.6 cm (range: 1.5–11.2 cm). The average hospital stay time for PLA patients was 19.5 ± 4.4 days (range: 6–71 days). The primary treatment method was a combination of antibiotics and percutaneous drainage (63.2%, 12/19). None of the 19 patients experienced recurrence of PLA. As of April 30, 2024, 11 of the 19 PLA patients had died, with 4 deaths occurring during hospitalization and 7 postdischarge deaths due to other tumor‐related complications. The average postoperative survival time of the 11 deceased patients was 13.3 ± 3.1 months. Among the 19 PLA patients, 4 underwent radiofrequency ablation (RFA) due to postoperative liver metastasis (21.1%, 4/19), all of whom developed PLA following RFA (100%, 4/4). Univariate analysis indicated that RFA is a risk factor for PLA after PD ( p = 0.003). The median survival time for the PLA (+) group was 16 months (95% CI: 10.7–21.3), significantly shorter than the 25 months (95% CI: 21.0–29.0) for the PLA (−) group. Patients in the PLA (+) group had a significantly higher risk of death compared to the PLA (−) group, with a hazard ratio (HR) of 2.83 (95% CI: 1.52–5.26; p = 0.001). Conclusion The incidence of PLA after PD is 5.4%. The combination of antibiotics and percutaneous drainage is a safe and effective treatment for PLA following PD. Postoperative RFA may be a risk factor for the development of PLA after PD. The median survival time for the PLA (+) group was shorter than that of the PLA (−) group.
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