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Journal of Gastrointestinal Surgery

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01-02-2017 | Original Article

Pancreatitis After Pancreatoduodenectomy Predicts Clinically Relevant Postoperative Pancreatic Fistula

Authors: C. M. Kühlbrey, N. Samiei, O. Sick, F. Makowiec, U. T. Hopt, U. A. Wittel

Published in: Journal of Gastrointestinal Surgery | Issue 2/2017

Abstract

Background

Morbidity after pancreas resection is still high with postoperative pancreatic fistulas (POPF) being the most frequent complication. However, exocrine insufficiency seems to protect from POPF. In clinical practice, patients showing increased postoperative systemic amylase concentrations appear to frequently develop POPF. We therefore retrospectively examined the occurrence of systemic amylase increase after pancreas resections and its association with the clinical course.

Patients and Methods

Perioperative data from 739 consecutive pancreas resections were assessed in a prospectively maintained SPSS database. Serum and drain amylase concentrations were determined by routine clinical chemistry. POPFs were graded into A–C according to ISGPF definitions.

Results

In patients with reduced serum amylase (n = 89) on day 1 after pancreatoduodenectomy, clinically relevant POPFs were not observed. In patients with normal serum amylase concentrations, clinically relevant POPFs occurred in 9 %, while in 39 % of the patients with more than three times elevated amylase concentrations, a clinically relevant postoperative fistula was observed (p < 0.001). Systemic hyperamylasemia detected on postoperative day 1 after pancreatoduodenectomy was further a good predictor for clinically relevant POPFs (AUROC = 0.797, p < 0.001).

Conclusion

Patients with a high risk for developing clinically relevant POPFs can be identified on the first postoperative day by determining serum amylase.

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Wittel, U. A. et al. Retrospective analyses of trends in pancreatic surgery: indications, operative techniques, and postoperative outcome of 1,120 pancreatic resections. World J. Surg. Oncol. 13, 102 (2015).CrossRefPubMedPubMedCentral

Fahy, B. N., Frey, C. F., Ho, H. S., Beckett, L. & Bold, R. J. Morbidity, mortality, and technical factors of distal pancreatectomy. Am. J. Surg. 183, 237–241 (2002).CrossRefPubMed

Katsourakis, A. et al. Does Prophylactic Administration of Somatostatin Decrease the Rates of Complications After Pancreatic Resection?: A Clinical and Electron Microscopy Study. Pancreas 42, 37–41 (2013).CrossRefPubMed

Bassi, C. et al. Postoperative pancreatic fistula: An international study group (ISGPF) definition. Surgery 138, 8–13 (2005).CrossRefPubMed

Hassenpflug, M. et al. Decrease in clinically relevant pancreatic fistula by coverage of the pancreatic remnant after distal pancreatectomy. Surgery 152, S164–S171 (2012).CrossRefPubMed

Diener, M. K. et al. Efficacy of stapler versus hand-sewn closure after distal pancreatectomy (DISPACT): a randomised, controlled multicentre trial. The Lancet 377, 1514–1522 (2011).CrossRef

Wellner, U. F. et al. Randomized controlled single-center trial comparing pancreatogastrostomy versus pancreaticojejunostomy after partial pancreatoduodenectomy. J. Gastrointest. Surg. Off. J. Soc. Surg. Aliment. Tract 16, 1686–1695 (2012).CrossRef

Crippa, S. et al. Pancreaticojejunostomy is comparable to pancreaticogastrostomy after pancreaticoduodenectomy: an updated meta-analysis of randomized controlled trials. Langenbecks Arch. Surg. 401, 427–437 (2016).

Callery, M. P., Pratt, W. B., Kent, T. S., Chaikof, E. L. & Vollmer, C. M. A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy. J. Am. Coll. Surg. 216, 1–14 (2013).CrossRefPubMed

10.

McMillan, M. T. et al. Drain Management after Pancreatoduodenectomy: Reappraisal of a Prospective Randomized Trial Using Risk Stratification. J. Am. Coll. Surg. 221, 798–809 (2015).CrossRefPubMed

11.

Palani Velu, L. K. et al. Serum amylase and C-reactive protein in risk stratification of pancreas-specific complications after pancreaticoduodenectomy. Br. J. Surg. 103, 553–563 (2016).CrossRefPubMed

12.

Cloyd, J. M., Kastenberg, Z. J., Visser, B. C., Poultsides, G. A. & Norton, J. A. Postoperative serum amylase predicts pancreatic fistula formation following pancreaticoduodenectomy. J. Gastrointest. Surg. Off. J. Soc. Surg. Aliment. Tract 18, 348–353 (2014).CrossRef

13.

Liu, Q.-Y. et al. Analysis of risk factors for postoperative pancreatic fistula following pancreaticoduodenectomy. World J. Gastroenterol. 20, 17491–17497 (2014).CrossRefPubMedPubMedCentral

14.

Uomo, G. et al. The incidence of main pancreatic duct disruption in severe biliary pancreatitis. Am. J. Surg. 176, 49–52 (1998).CrossRefPubMed

15.

Lau, S. T., Simchuk, E. J., Kozarek, R. A. & Traverso, L. W. A pancreatic ductal leak should be sought to direct treatment in patients with acute pancreatitis. Am. J. Surg. 181, 411–415 (2001).CrossRefPubMed

16.

Fujiwara, Y. et al. A novel postoperative inflammatory score predicts postoperative pancreatic fistula after pancreatic resection. Anticancer Res. 33, 5005–5010 (2013).PubMed

17.

Ridolfi, C. et al. Morphohistological features of pancreatic stump are the main determinant of pancreatic fistula after pancreatoduodenectomy. BioMed Res. Int. 2014, 641239 (2014).

18.

Okabayashi, T. et al. Postoperative pancreatic fistula following distal pancreatectomy for pancreatic neoplasm; can pancreatic fistula be prevented? Hepatogastroenterology. 51, 1838–1841 (2004).PubMed

19.

Palani Velu, L. K. et al. Serum amylase on the night of surgery predicts clinically significant pancreatic fistula after pancreaticoduodenectomy. HPB 16, 610–619 (2014).CrossRefPubMed

20.

Lermite, E. et al. Risk Factors of Pancreatic Fistula and Delayed Gastric Emptying after Pancreaticoduodenectomy with Pancreaticogastrostomy. J. Am. Coll. Surg. 204, 588–596 (2007).CrossRefPubMed

21.

Bassi, C. et al. Reconstruction by pancreaticojejunostomy versus pancreaticogastrostomy following pancreatectomy: results of a comparative study. Ann. Surg. 242, 767–773 (2005)

22.

Wente, M. N. et al. Pancreaticojejunostomy versus pancreaticogastrostomy: systematic review and meta-analysis. Am. J. Surg. 193, 171–183 (2007).CrossRefPubMed

23.

Koch, M. et al. Bile leakage after hepatobiliary and pancreatic surgery: A definition and grading of severity by the International Study Group of Liver Surgery. Surgery 149, 680–688 (2011).CrossRefPubMed

Title: Pancreatitis After Pancreatoduodenectomy Predicts Clinically Relevant Postoperative Pancreatic Fistula
Authors: C. M. Kühlbrey
N. Samiei
O. Sick
F. Makowiec
U. T. Hopt
U. A. Wittel
Publication date: 01-02-2017
Publisher: Springer US
Published in: Journal of Gastrointestinal Surgery / Issue 2/2017
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-016-3305-x

At a glance: The STEP trials

Springer Medicine

Pancreatitis After Pancreatoduodenectomy Predicts Clinically Relevant Postoperative Pancreatic Fistula

Abstract

Background

Patients and Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Patients and Methods

Results

Conclusion

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