Evaluation of preoperative risk factors for postpancreatectomy hemorrhage

Izumo, Wataru; Higuchi, Ryota; Yazawa, Takehisa; Uemura, Shuichiro; Shiihara, Masahiro; Yamamoto, Masakazu

doi:10.1007/s00423-019-01830-w

Cited by 42 publications

(38 citation statements)

References 32 publications

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“…Another study conducted multivariate modeling and identified several risk factors, including advanced age, increased body mass index, intraoperative transfusion, portal venous and multivisceral resections, and POPFs, for severe PPH (18). Izumo et al found that the absence of diabetes mellitus and POPFs are risk factors for PPH in patients who underwent PD (19). In contrast to patients in these studies, our patient lacked POPFs.…”

Section: Discussionmentioning

confidence: 59%

Rare postoperative hemorrhage after robotic-assisted pancreatoduodenectomy for pancreatic head cancer: a case report

Zhou¹,

Chen²,

Zou³

et al. 2020

J Gastrointest Oncol

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Post-pancreaticoduodenectomy hemorrhage is a life-threatening complication that occurs in 2-10% of patients. The most common location for post-pancreaticoduodenectomy hemorrhage is the gastroduodenal artery stump. Nonetheless, unusual sources of hemorrhage, which are hard to locate, exist. Here, we report a rare postoperative hemorrhage after robotic-assisted pancreatoduodenectomy for pancreatic head cancer. A 67-year-old man presenting with appetite loss, general fatigue and painless jaundice was admitted to our ward. The patient had an elevated level of carbohydrate antigen 19-9 (50 U/mL). Computed tomography scan revealed a 17-mm wide low-density area in the uncinate process of the pancreas. Magnetic resonance cholangiopancreatography showed the dilation of bile and pancreatic ducts. Robotic-assisted pancreaticoduodenectomy was performed on the patient by using the da Vinci Model S Surgical System. On postoperative days 5 and 6, the patient vomited blood, and bloody fluid was observed in the drainage. Emergent gastroscopic examination was performed and revealed a large amount of hematocele in the stomach. On postoperative day 6, emergency operation was undertaken, and the output jejunal loop was found to have intussuscepted in the stomach. This is the first case report of output jejunal loop intussusception in the stomach that consequently caused hemorrhage after robotic-assisted pancreaticoduodenectomy for pancreatic head cancer.

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Section: Discussionmentioning

confidence: 59%

Rare postoperative hemorrhage after robotic-assisted pancreatoduodenectomy for pancreatic head cancer: a case report

Zhou¹,

Chen²,

Zou³

et al. 2020

J Gastrointest Oncol

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“…A prospective validation study showed that a soft pancreas is believed to be more prone to developing POPF ( P = 0.002) [ 7 ]. The texture of the pancreas is positively associated with contained acini [ 27 ]. Fibrotic pancreatic tissue, usually with acini regeneration and impaired secretion function, is believed to be less prone to pancreatic leakage [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Predictive nomogram for postoperative pancreatic fistula following pancreaticoduodenectomy: a retrospective study

et al. 2021

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Background Postoperative pancreatic fistula (POPF) represents the most common complication following pancreaticoduodenectomy (PD). Predictive models are needed to select patients with a high risk of POPF. This study was aimed to establish an effective predictive nomogram for POPF following PD. Methods Consecutive patients who had undergone PD between January 2016 and May 2020 at a single institution were analysed retrospectively. A predictive nomogram was established based on a training cohort, and Lasso regression and multivariable logistic regression analysis were used to evaluate predictors. The predictive abilities of the predicting model were assessed for internal validation by the area under the receiver operating characteristic curve (AUC) and calibration plot using bootstrap resampling. The performance of the nomogram was compared with that of the currently used a-FRS model. Results A total of 459 patients were divided into a training cohort (n = 302) and a validation cohort (n = 157). No significant difference was observed between the two groups with respect to clinicopathological characteristics. The POPF rate was 16.56%. The risk factors of POPF POPF were albumin difference, drain amylase value on postoperative day 1, pancreas texture, and BMI, which were all selected into a nomogram. Nomogram application revealed good discrimination (AUC = 0.87, 95% CI: 0.81–0.94, P < 0.001) as well as calibration abilities in the validation cohort. The predictive value of the nomogram was better than that of the a-FRS model (AUC: 0.87 vs 0.62, P < 0.001). Conclusions This predictive nomogram could be used to evaluate the individual risk of POPF in patients following PD, and albumin difference is a new, accessible predictor of POPF after PD. Trial registration This study was registered in the Chinese Clinical Trial Register (ChiCTR2000034435).

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“…Recent reports have shown that potential risk factors for PPH following PD include body mass index (BMI), intraoperative transfusion, portal vein resection, POPF, preoperative biliary drainage, absence of diabetes, and lower serum albumin level [ 5 , 20 , 21 ]. However, the definite risk factor for PPH following PD was still unknown.…”

Section: Discussionmentioning

confidence: 99%

Geriatric Nutritional Risk Index Less Than 92 Is a Predictor for Late Postpancreatectomy Hemorrhage Following Pancreatoduodenectomy: A Retrospective Cohort Study

Funamizu

Omura

Takada

et al. 2020

Cancers

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Postpancreatectomy hemorrhage (PPH) is the most lethal complication of pancreatoduodenectomy (PD). The main risk factor for PPH is the development of a postoperative pancreatic fistula (POPF). Recent evidence shows that the geriatric nutritional risk index (GNRI) may be predictive indicator for POPF. In this study, we aimed to evaluate whether GNRI is a reliable predictive marker for PPH following PD. The present study retrospectively evaluated 121 patients treated with PD at Ageo Central General Hospital in Japan between January 2015 and March 2020. We investigated the potential of age, gender, body mass index, serum albumin, American Society of Anesthesiologists classification (ASA), diabetes mellitus and smoking status, time taken for the operation, estimated blood loss, and postoperative complications (POPF, bile leak, and surgical site infections) to predict the risk of PPH following PD using univariate and multivariate analyses. Ten patients had developed PPH with an incidence of 8.3%. Among them, the patients were divided into bleeding group (n = 10) and non-bleeding group (n = 111). The bleeding group had significantly lower GNRI values than those in the non-bleeding group (p = 0.001). We determined that the cut-off value of GNRI was 92 accounting for a sensitivity 80.0%, specificity 82.9%, and likelihood ratio of 4.6 using receiver operating characteristic curve analysis. A GNRI of <92 was statistically associated with PPH in both univariate (p < 0.001) and multivariate analysis (p = 0.01). Therefore, we could identify that a GNRI < 92 was an independently potential predictor of PPH risk following PD. We should alert surgeons if patients have low level GNRI before PD.

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Evaluation of preoperative risk factors for postpancreatectomy hemorrhage

Cited by 42 publications

References 32 publications

Rare postoperative hemorrhage after robotic-assisted pancreatoduodenectomy for pancreatic head cancer: a case report

Rare postoperative hemorrhage after robotic-assisted pancreatoduodenectomy for pancreatic head cancer: a case report

Predictive nomogram for postoperative pancreatic fistula following pancreaticoduodenectomy: a retrospective study

Geriatric Nutritional Risk Index Less Than 92 Is a Predictor for Late Postpancreatectomy Hemorrhage Following Pancreatoduodenectomy: A Retrospective Cohort Study

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