Intraoperative amylase level of pancreatic juice as a simple predictor of pancreatic fistula after pancreaticoduodenectomy

Furukawa, Kiyonori; Gocho, Takeshi; Sakamoto, Taro; Tsunematsu, Masashi; Haruki, Koichiro; Horiuchi, Takashi; Shirai, Yoshio; Yasuda, Jungo; Shiozaki, Hironori; Onda, Shinji; Shiba, Hiroaki; Sato, Shun; Takahashi, Hiroyuki; Ikegami, Toru

doi:10.1016/j.pan.2020.10.048

Cited by 4 publications

(9 citation statements)

References 25 publications

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“…We furthermore evaluated the postinterventional serum amylase levels They only showed a non-significant increase. As elevated serum-amylase levels may correlate with the presence of POPF [ 37 , 38 ], this could support the theory of a clinically stable situation under CTD. However, an increase in amylase could also be due to postoperative pancreatitis, for instance.…”

Section: Discussionmentioning

confidence: 63%

Low-Milliampere CT Fluoroscopy-Guided Percutaneous Drainage Placement after Pancreatic Surgery: Technical and Clinical Outcome in 133 Consecutive Patients during a 14-Year Period

Trumm

Hackner²,

Badmann³

et al. 2022

Diagnostics

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(1) Purpose: To retrospectively assess the technical and clinical outcome of patients with symptomatic postoperative fluid collections after pancreatic surgery, treated with CT-guided drainage (CTD). (2) Methods: 133 eligible patients between 2004 and 2017 were included. We defined technical success as the sufficient drainage of the fluid collection(s) and the absence of peri-interventional complications (minor or major according to SIR criteria). Per definition, clinical success was characterized by normalization of specific blood parameters within 30 days after the intervention or a decrease by at least 50% without requiring additional surgical revision. C-reactive protein (CRP), Leukocytes, Interleukin-6, and Dose length product (DLP) for parts of the intervention were determined. (3) Results: 97.0% of 167 interventions were technically successful. Clinical success was achieved in 87.5% of CRP, in 78.4% of Leukocytes, and in 87.5% of Interleukin-6 assessments. The median of successful decrease was 6 days for CRP, 5 days for Leukocytes, and 2 days for Interleukin-6. No surgical revision was necessary in 93.2%. DLP was significantly lower in the second half of the observation period (total DLP: median 621.5 mGy*cm between 2011–2017 vs. median 944.5 mGy*cm between 2004–2010). (4) Conclusions: Technical success rate of CTD was very high and the clinical success rate was fair to good. Given an elderly and multimorbid patient cohort, CTD can have a temporizing effect in the postoperative period after pancreatic surgery. Reducing the radiation dose over time might reflect developments in CT technology and increased experience of interventional radiologists.

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Section: Discussionmentioning

confidence: 63%

Low-Milliampere CT Fluoroscopy-Guided Percutaneous Drainage Placement after Pancreatic Surgery: Technical and Clinical Outcome in 133 Consecutive Patients during a 14-Year Period

Trumm

Hackner²,

Badmann³

et al. 2022

Diagnostics

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“…A current study reported that the patients with a soft pancreas would not develop POPF when the preoperative faecal elastase 1 was <260 mcg/g 63 . Furthermore, some studies figured out that soft texture was a non‐independent risk factor 64,65 . A large sample size study even pointed out that gland texture was not associated with CR‐POPF 57 …”

Section: Discussionmentioning

confidence: 84%

“…63 Furthermore, some studies figured out that soft texture was a non-independent risk factor. 64,65 A large sample size study even pointed out that gland texture was not associated with CR-POPF. 57 In conclusion, the results of this study manifested that the level of serum ALB and the thickness of the pancreatic parenchyma were significantly associated with the incidence of CR-POPF.…”

Section: Discussionmentioning

confidence: 99%

The net parenchymal thickness predicts pancreatic fistula after pancreaticoduodenectomy: a retrospective cohort study of objective data

Jia

Liu

et al. 2022

ANZ Journal of Surgery

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Background: The clinically relevant postoperative pancreatic fistula (CR-POPF) is still a challenging complication of pancreaticoduodenectomy (PD). This study aims to explore the predictors of CR-POPF after PD, including net parenchymal thickness (NPT) of pancreatic neck. Methods: The consecutive patients who underwent PD at a tertiary hospital were retrospectively reviewed. Univariate and multivariate analyses were conducted on the perioperative data, which was mainly extracted from the objective data, containing the results from the laboratory tests and the imaging examination. NPT refers to the total thickness of pancreatic gland excluding main pancreatic duct (MPD) at the CT film. Results: Univariate analyses showed that total serum bilirubin (TBiL) and albumin (ALB) levels, MPD size and NPT were significantly different between the patients with and without CR-POPF. The white blood cell count, the rate of intra-abdominal infection (IAI) and the postoperative length of hospital stay (LOS) were associated with the incidence of CR-POPF. The proportion of patients with pancreatic adenocarcinoma or chronic pancreatitis was significantly lower in the CR-POPF group than in the non-CR-POPF group. Multivariate analyses manifested that ALB ≤35 g/L and NPT >10 mm were two of the independent risk factors for CR-POPF. Conclusion: Preoperative ALB ≤35 g/L and NPT > 10 mm were both the independent predictors of CR-POPF. CR-POPF was associated with the higher IAI rate and the extended LOS.

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“…Paraffin‐embedded sections from pancreatic stump were stained with hematoxylin and eosin and reviewed by an experienced gastrointestinal pathologist who was blinded to the surgical outcome. The degree of fibrosis was assessed quantitatively by calculating the ratio of the dimension of intralobular and interlobular fat to the total area of each specimen as described in the previous report 11 …”

Section: Methodsmentioning

confidence: 99%

“…We considered that the exocrine function of the remnant pancreas might represent a useful predictor of NAFLD in patients who undergo PD. The intraoperative amylase activity in pancreatic juice is reported to be a valuable predictor of POPF following PD 10,11 . Intraoperative amylase activity in pancreatic juice negatively correlates with the severity of pancreatic fibrosis, 11 suggesting that it is likely to reflect postoperative pancreatic exocrine function.…”

Section: Introductionmentioning

confidence: 99%

The impact of postoperative exocrine index on non‐alcoholic fatty liver disease following pancreaticoduodenectomy

Tsunematsu

Gocho

Yanagaki

et al. 2022

Annals of Gastroent Surgery

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Background: To study exocrine function of the remnant pancreas after pancreatoduodenectomy (PD), we propose the use of an exocrine index (PEI) that combines the volume of the remnant pancreas and the intraoperative amylase activity of the pancreatic juice. Here, we aimed to determine whether the PEI can predict non-alcoholic fatty liver disease (NAFLD) following PD.Methods: Fifty-seven patients for whom pancreatic juice amylase activity was measured during PD were enrolled. NAFLD was defined as a liver-to-spleen attenuation ratio of <0.9 on plain CT 1 year following surgery. We retrospectively evaluated clinical parameters, including the PEI, to identify predictors of NAFLD.Results: Fifty-four patients (95%) were regularly administered 1200 mg of pancreatic lipase. NAFLD was diagnosed in 13 participants (23%) 1 year following surgery.NAFLD was associated with pancreatic ductal adenocarcinoma (P = .006), soft pancreas (P = .001), small main pancreatic duct (P = 0008), low remnant pancreatic volume (P < .001), low intraoperative amylase activity in the pancreatic juice (P = .001), high pancreatic fibrosis (P = .032), and large body weight loss (P = .015). The PEI was significantly lower in the participants with NAFLD than in those without (P < .001).The participants were then classified into tertiles of PEI: <5 × 10 6 , 5-25 × 10 6 , and >25 × 10 6 . The prevalence of NAFLD in these groups was 53% (10/19), 11% (2/19), and 5% (1/19), respectively. In multivariable analyses, there was a significant association between NAFLD and the PEI (P value for trend = .042). Conclusion:The PEI, calculated using the remnant pancreatic volume and the intraoperative pancreatic juice amylase activity, predicts NAFLD development following PD.

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Intraoperative amylase level of pancreatic juice as a simple predictor of pancreatic fistula after pancreaticoduodenectomy

Cited by 4 publications

References 25 publications

Low-Milliampere CT Fluoroscopy-Guided Percutaneous Drainage Placement after Pancreatic Surgery: Technical and Clinical Outcome in 133 Consecutive Patients during a 14-Year Period

Low-Milliampere CT Fluoroscopy-Guided Percutaneous Drainage Placement after Pancreatic Surgery: Technical and Clinical Outcome in 133 Consecutive Patients during a 14-Year Period

The net parenchymal thickness predicts pancreatic fistula after pancreaticoduodenectomy: a retrospective cohort study of objective data

The impact of postoperative exocrine index on non‐alcoholic fatty liver disease following pancreaticoduodenectomy

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