Analysis of predictors for postoperative complications after pancreatectomy––what is new after establishing the definition of postpancreatectomy acute pancreatitis (PPAP)?

Abstract

Purpose We aimed to analyze the predictive value of hyperamylasemia after pancreatectomy for morbidity and for the decision to perform rescue completion pancreatectomy (CP) in a retrospective cohort study. Methods Data were extracted from a retrospective clinical database. Postoperative hyperamylasemia (POH) and postoperative hyperlipasemia (POHL) were defined by values greater than those accepted as the upper limit at our institution on postoperative day 1 (POD1). The endpoints of the study were the association of POH with postoperative morbidity and the possible predictors for postpancreatectomy acute pancreatitis (PPAP) and severe complications such as the necessity for rescue CP. Results We analyzed 437 patients who underwent pancreaticoduodenectomy over a period of 7 years. Among them, 219 (52.3%) patients had POH and 200 (47.7%) had normal postoperative amylase (non-POH) levels. A soft pancreatic texture (odds ratio [OR] 3.86) and POH on POD1 (OR 8.2) were independent predictors of postoperative pancreatic fistula (POPF), and POH on POD1 (OR 6.38) was an independent predictor of rescue CP. The clinically relevant POPF (49.5% vs. 11.4%, p < 0.001), intraabdominal abscess (38.3% vs. 15.3%, p < 0.001), postoperative hemorrhage (22.8% vs. 5.1%, p < 0.001), major complications (Clavien-Dindo classification > 2) (52.5% vs. 25.6%, p < 0.001), and CP (13% vs. 1.8%, p < 0.001) occurred significantly more often in the POH group than in the non-POH group. Conclusion Although POH on POD1 occurs frequently, in addition to other risk factors, it has a predictive value for the development of postoperative morbidity associated with PPAP and CP.

Association of Postoperative Hyperamylasemia With Clinically Relevant Postoperative Pancreatic Fistula in Pancreatoduodenectomy

“…Radulova et al showed a POH1 rate of 52.3% in 437 patients, with soft pancreatic texture and POH on POD1 being independent predictors of POPF. The CR-POPF, major complications (Clavien-Dindo classification > 2), and completion pancreatectomy rates were significantly higher in the POH group [8]. Kuhlbrey et al showed in a retrospective study of 739 consecutive PDs that POD1 systemic hyperamylasemia was a good predictor for CR-POPFs [16].…”

“…The first attempt at a standard definition of PPAP was made by Connor et al in 2016 who defined PPAP as the elevation of serum amylase levels (hyperamylasemia) above the institutional upper limit of normal on postoperative days (POD) 0 or 1 [6]. Several retrospective studies have found postoperative hyperamylasemia of POD0 or 1 to be significantly associated with a higher rate of POPF [7][8][9][10][11][12].…”

Risk Factors of Postoperative Acute Pancreatitis and Its Impact on the Postoperative Course after Pancreaticoduodenectomy—10 Years of Single-Center Experience

“…In a recent study already based on the new ISGPS definition of PPAP, the risk of a rescue complete pancreatectomy in patients after PD was retrospectively assessed. Postoperative hyperamylasemia on POD 1 (regardless of the presence of CR-PPAP) was identified as an independent risk factor of complete pancreatectomy [29]. A reoperation with total pancreatectomy has a high mortality rate but serves as an emergency procedure to deal with potentially fatal complications of PD [44,45].…”

“…According to the hypothesis, anastomosis leakage develops as a consequence of necrosis in the pancreatic stump [11,28]. Proper surgical technique, including the use of fine sutures and delicate knotting for the pancreatic anastomosis, is also considered important [29].…”