Implications of Postpancreatectomy Hypophosphatemia

Wong, Paul; White, Michael G.; Tozzi, Federico; Warner, Susanne G.; Woo, Yanhgee; Singh, Gagandeep; Fong, Yuman; Melstrom, Laleh G.

doi:10.1177/0003134820949517

Cited by 2 publications

(17 citation statements)

References 30 publications

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“…The studies spanned from 2018 to 2020. All studies were retrospective analyses [ 11 , 22 , 23 ]. Patients older than 18 years old who underwent pancreatic resection for any reason were included.…”

Section: Resultsmentioning

confidence: 99%

“…The criteria for excluding patients were as follows: patients younger than 18 years old, patients who underwent re-operations or multivisceral, debulking operations. Postoperative serum phosphate levels, incidence of postoperative pancreatic fistulas, demographics, clinicopathological and postoperative observation data, and comorbidities were evaluated [ 11 , 22 , 23 ]. Various complications such as infectious, abdominal collection/fistula, bleeding/anemia, gastrointestinal, cardiopulmonary, and others were identified.…”

Section: Resultsmentioning

confidence: 99%

“…The serum phosphate levels were collected at the preoperative visit (within two weeks of surgery) and daily from the day of surgery until discharge in the study by Sadot et al [ 22 ]. Serum phosphate levels were recorded and collected for 10 days postoperatively in the study by Wong et al [ 23 ]. The definition of hypophosphatemia also varied between the included studies.…”

Section: Resultsmentioning

confidence: 99%

“…The definition of hypophosphatemia also varied between the included studies. Hypophosphatemia was defined as a serum phosphate level less than 2.5 mg/dL in the study by Wong et al, less than 2.4 mg/dL in the study by Sadot et al, and in the study by Mueller et al, it was not mentioned [ 11 , 22 , 23 ]. In one of the included studies [ 21 ], the authors applied further stratification of hypophosphatemia into different levels of severity: mild (2.5–2.0 mg/dL) and moderate/severe (<2.0 mg/dL).…”

Section: Resultsmentioning

confidence: 99%

“…Because of acute hypophosphatemia, diverse clinical manifestations may be observed [ 20 , 21 ]. In patients following gastrointestinal surgeries, lower serum phosphate levels are associated with poor outcomes and an increased incidence of organ-specific complications (OSC), including intra-abdominal infections, abscesses, and fistulas [ 22 , 23 ]. Contrarily, following hepatectomy, hypophosphatemia is associated with reduced morbidity and mortality, with several mechanisms being described [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

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Postoperative Hypophosphatemia as a Prognostic Factor for Postoperative Pancreatic Fistula: A Systematic Review

Grikyte

Ignatavičius

2023

Medicina

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Background and Objectives: Postoperative pancreatic fistula (POPF) is one of the most challenging complications after pancreatic resections, associated with prolonged hospital stay and high mortality. Early identification of pancreatic fistula is necessary for the treatment to be effective. Several prognostic factors have been identified, although it is unclear which one is the most crucial. Some studies show that post-pancreatectomy hypophosphatemia may be associated with the development of POPF. The aim of this systematic review was to determine whether postoperative hypophosphatemia can be used as a prognostic factor for postoperative pancreatic fistula. Materials and Methods: The systematic literature review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations (PRISMA) and was registered in the International Prospective Register of Systematic Reviews (PROSPERO). The PubMed, ScienceDirect, and Web of Science databases were systematically searched up to the 31st of January 2022 for studies analyzing postoperative hypophosphatemia as a prognostic factor for POPF. Data including study characteristics, patient characteristics, operation type, definitions of postoperative hypophosphatemia and postoperative pancreatic fistula were extracted. Results: Initially, 149 articles were retrieved. After screening and final assessment, 3 retrospective studies with 2893 patients were included in this review. An association between postoperative hypophosphatemia and POPF was found in all included studies. Patients undergoing distal pancreatectomy were more likely to develop severe hypophosphatemia compared to patients undergoing proximal pancreatectomy. Serum phosphate levels on postoperative day 4 (POD 4) and postoperative day 5 (POD 5) remained significantly lower in patients who developed leak-related complications showing a slower recovery of hypophosphatemia from postoperative day 3 (POD 3) through postoperative day 7 (POD 7). Moreover, body mass index (BMI) higher than 30 kg/m2, soft pancreatic tissue, abnormal white blood cell count on postoperative day 3 (POD 3), and shorter surgery time were associated with leak-related complications (LRC) and lower phosphate levels. Conclusions: Early postoperative hypophosphatemia might be used as a prognostic biomarker for early identification of postoperative pancreatic fistula. However, more studies are needed to better identify significant cut-off levels of postoperative hypophosphatemia and development of hypophosphatemia in the postoperative period.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Postoperative Hypophosphatemia as a Prognostic Factor for Postoperative Pancreatic Fistula: A Systematic Review

Grikyte

Ignatavičius

2023

Medicina

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Hypophosphatemia in Patients With Multiple Myeloma

Cancarevic¹,

Ilyas²,

Nassar³

2023

Cureus

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Hypophosphatemia is among the most common electrolyte abnormalities, especially among patients with underlying malignancies, and is frequently associated with adverse prognoses. Phosphorus levels are regulated through a number of mechanisms, including parathyroid hormone (PTH), fibroblast growth factor-23 (FGF-23), vitamin D, and other electrolyte levels themselves. Clinically, the findings are nonspecific, and the diagnosis is frequently delayed. This article is a narrative literature review. The PubMed database was searched for relevant articles pertaining to hypophosphatemia causes and consequences in patients suffering from multiple myeloma. We found a variety of causes of hypophosphatemia in patients with multiple myeloma. Tumor-induced osteopenia, although more common among patients with small squamous cell carcinomas, can occur with multiple myeloma as well. Additionally, both light chains themselves and medications can trigger Fanconi syndrome, which leads to phosphorus wasting by the kidney. Bisphosphonates, in addition to being a possible cause of Fanconi syndrome, lead to a decrease in calcium levels, which then stimulates parathyroid hormone (PTH) release, predisposing the patient to significant hypophosphatemia. Additionally, many of the more modern medications used to manage multiple myeloma have been associated with hypophosphatemia. A better understanding of those mechanisms may give clinicians a clearer idea of which patients may need more frequent screening as well as what the potential triggers in the individual patient may be.

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Implications of Postpancreatectomy Hypophosphatemia

Cited by 2 publications

References 30 publications

Postoperative Hypophosphatemia as a Prognostic Factor for Postoperative Pancreatic Fistula: A Systematic Review

Postoperative Hypophosphatemia as a Prognostic Factor for Postoperative Pancreatic Fistula: A Systematic Review

Hypophosphatemia in Patients With Multiple Myeloma

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