A Normal Preoperative Lipase Serum Level Is an Easy and Objective Risk Factor of Pancreatic Fistula After Pancreaticoduodenectomy

Gagnière, Johan; Abjean, Adeline; Franz, Martin; Aumont, Ophélie; Pereira, Bruno; Dupré, Aurélien; Véziant, Julie; Roy, Bertrand Le; Boyer, L.; Pezet, Denis; Buc, Emmanuel

doi:10.1097/mpa.0000000000000905

Cited by 6 publications

(4 citation statements)

References 42 publications

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“…Some 23 665 patients had malignant disease and of these 12 097 had pancreatic ductal adenocarcinoma, 3778 distal cholangiocarcinoma, 3189 ampullary carcinoma and 1456 duodenal carcinoma. Study characteristics are summarized in Table S3 14–126 . Ninety‐one studies were retrospective cohort studies, 28 prospective cohort studies and three randomized controlled trials.…”

Section: Resultsmentioning

confidence: 99%

Systematic review and meta‐analysis of factors associated with post‐operative pancreatic fistula following pancreatoduodenectomy

Kamarajah

Bundred

Lin

et al. 2020

ANZ Journal of Surgery

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Background Many studies have explored factors relating to post‐operative pancreatic fistula (POPF); however, the original definition (All‐POPF) was revised to include only ‘clinically relevant’ (CR) POPF. This study identified variables associated with the two International Study Group on Pancreatic Surgery definitions to identify which variables are more strongly associated with CR‐POPF. Methods A systematic review identified all studies reporting risk factors for POPF (using both International Study Group on Pancreatic Fistula definitions) following pancreatoduodenectomy. The primary outcome was factors associated with CR‐POPF. Meta‐analyses (random effects models) of pre‐, intra‐ and post‐operative factors associated with POPF in more than two studies were included. Results Among 52 774 patients All‐POPF (n = 69 studies) and CR‐POPF (n = 53 studies) affected 27% (95% confidence interval (CI95%) 23–30) and 19% (CI95% 17–22), respectively. Of the 176 factors, 24 and 17 were associated with All‐ and CR‐POPF, respectively. Absence of pre‐operative pancreatitis, presence of renal disease, no pre‐operative neoadjuvant therapy, use of post‐operative somatostatin analogues, absence of associated venous or arterial resection were associated with CR‐POPF but not All‐POPF. Conclusion In conclusion this study demonstrates wide variation in reported rates of POPF and that several risk factors associated with CR‐POPF are not used within risk prediction models. Data from this study can be used to shape future studies, research and audit across ethnic and geographic boundaries in POPF following pancreatoduodenectomy.

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Section: Resultsmentioning

confidence: 99%

Systematic review and meta‐analysis of factors associated with post‐operative pancreatic fistula following pancreatoduodenectomy

Kamarajah

Bundred

Lin

et al. 2020

ANZ Journal of Surgery

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“…Over the past few decades, many studies ( 14 – 18 , 23 – 25 ) have reported that the risk factors for postoperative complications after PD include a soft pancreatic texture, a small pancreatic duct diameter, a high BMI, preoperative biliary drainage, operative blood loss, and sarcopenia. However, the patients enrolled in these studies have included a mixture of those with distal cholangiocarcinoma and pancreatic head cancer.…”

Section: Discussionmentioning

confidence: 99%

“…Although the mortality rate of PD has decreased satisfactorily to 5.0% in high volume centers, due to improvements in surgical techniques and perioperative management, the postoperative morbidity rate remains high, with values ranging from 30.0–65.0% ( 14 , 15 ). Several studies ( 16 – 18 ) have reported risk factors for postoperative complications after PD. However, the patients recruited to these studies included those with distal cholangiocarcinoma, as well as, pancreatic head cancer.…”

Section: Introductionmentioning

confidence: 99%

Neutrophil‑to‑lymphocyte ratio as a predictor of postoperative morbidity in patients with distal cholangiocarcinoma

et al. 2018

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Systemic inflammatory-, immunological- and nutritional-based indices, such as the neutrophil-to-lymphocyte ratio (NLR), the prognostic nutritional index (PNI) and the Glasgow prognostic score (GPS), are drawing considerable research attention to predict the long-term prognosis of many types of cancer. Recently, these parameters have also been reported to be useful in predicting postoperative morbidity in several fields, including colorectal and otolaryngological cancer. However, while distal cholangiocarcinoma exhibits a high morbidity rate, its risk factors of morbidity have not yet been established. This is because previous studies have analyzed distal cholangiocarcinoma as periampullary tumors combined with pancreatic head cancer. Therefore, the aim of the present study was to investigate the application of the NLR, the PNI and the GPS in evaluating risk factors for postoperative morbidity in patients with distal cholangiocellular or ampullary carcinoma. Eighty-four patients who underwent pancreaticoduodenectomy (PD) for distal cholangiocellular or ampullary carcinoma at the Department of Surgery in Kitasato University Hospital between 2008 and 2016 were enrolled. Associations between perioperative characteristics (NLR, PNI and GPS) and postoperative complications (Clavien-Dindo classification grade III or higher) were retrospectively analyzed. In the univariate analysis, neutrophil and lymphocyte counts, body mass index (BMI) and the NLR were associated with postoperative complications (P<0.05). In the multivariate analysis, BMI [>23.0 kg/m2; odds ratio (OR): 3.80, 95.0% confidence interval (CI): 1.35–11.83; P=0.011] and the NLR (>2.0; OR: 6.77, 95.0% CI: 2.44–21.13; P<0.001) were independent risk factors for postoperative complications. BMI and the NLR are valuable predictors of postoperative morbidity following PD in patients with distal cholangiocarcinoma. It would be beneficial to determine treatment strategies for distal cholangiocarcinoma based on the NLR to reduce postoperative complications.

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“…Based on this, several studies have reported on the effectiveness of serum and DLIP levels. Gagnière et al reported that a normal preoperative lipase serum level of ≤ 300 IU/L was a predictive preoperative risk factor for POPF (OR = 7.6, p < 0.001) [33]. Facy et al measured the DLIP level between 3 and 5 days after pancreatic surgery, and a DLIP level of ≥ 500 U/L correlated significantly with the presence of POPF [34].…”

Section: Discussionmentioning

confidence: 99%

Drain Lipase Levels and Decreased Rate of Drain Amylase Levels as Independent Predictors of Pancreatic Fistula with Nomogram After Pancreaticoduodenectomy

et al. 2021

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Background Pancreaticoduodenectomy (PD) has recently been improved due to its increased safety. However, postoperative pancreatic fistula (POPF) remains a lethal complication of PD. Identifying novel clinicophysiological risk factors for POPF during the early post‐PD period would help improve patient morbidity and mortality. Therefore, this retrospective study aimed to evaluate possible risk factors during the early postoperative period after pancreaticoduodenectomy (PD). Methods Data from 349 patients who underwent PD between 2007 and 2012 were examined retrospectively. All patients were classified into 2 groups: group A, patients without fistulae or biochemical leaks (288 patients), and group B, those with grade B or C POPF (61 patients). Data on various clinicophysiological parameters, including serum and drain laboratory data, were collected. Univariate and multivariate analyses were performed to evaluate POPF predictors. A predictive nomogram was established for these results. Results Univariate analysis showed that various serum and drain‐related factors, such as white blood cell count, C‐reactive protein levels, drain amylase (DAMY) levels, and drain lipase (DLIP) levels, were possible POPF risk factors. Multivariate analysis confirmed that postoperative day (POD) 1 DLIP levels (hazard ratio, 15.393; p = 0.037) and decreased rate (POD3/1) of DAMY levels (hazard ratio, 4.415; p = 0.028) were independent risk factors. Further, POD1 DLIP levels and decreased rate of DAMY levels were significantly lower in group A than in group B. The accuracy of nomogram was 0.810. Conclusions POD1 DLIP levels (> 245 U/mL) and decreased rate of DAMY levels (> 0.44) were POPF risk factors, making them possible biomarkers for POPF.

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A Normal Preoperative Lipase Serum Level Is an Easy and Objective Risk Factor of Pancreatic Fistula After Pancreaticoduodenectomy

Abstract: A normal preoperative LSL was a strong, easy, and objective preoperative risk factor of POPF. Its addition to the Fistula Risk Score improved its performance and allows a more accurate evaluation of the risk of POPF.

Cited by 6 publications

References 42 publications

Systematic review and meta‐analysis of factors associated with post‐operative pancreatic fistula following pancreatoduodenectomy

Systematic review and meta‐analysis of factors associated with post‐operative pancreatic fistula following pancreatoduodenectomy

Neutrophil‑to‑lymphocyte ratio as a predictor of postoperative morbidity in patients with distal cholangiocarcinoma

Drain Lipase Levels and Decreased Rate of Drain Amylase Levels as Independent Predictors of Pancreatic Fistula with Nomogram After Pancreaticoduodenectomy

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