Natural history and therapeutic strategies of post-pancreatoduodenectomy abdominal fluid collections

Zhao, Ning; Cui, Jing; Yang, Zhiyong; Xiong, Jie; Wu, Heshui; Wang, Chunyou; Peng, Tao

doi:10.1097/md.0000000000015792

Cited by 8 publications

(8 citation statements)

References 65 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In addition, the more the patient's nutritional status declines sharply; and the nutritional status of the patient directly affects the patient's postoperative recovery. Furthermore, the smaller the inner diameter of the pancreatic duct, the more likely it is to cause pancreatic fistula, which has been confirmed by most scholars (19)(20)(21)(22). Finally, an explanation for why we included INR-PT (international normalized ratio of prothrombin time) as a risk factor in our formula, although its P value (P=0.058) is greater than 0.05, is warranted.…”

Section: Discussionmentioning

confidence: 61%

“…With regard to the pre-existing comorbidity of respiratory diseases, it has already been widely accepted as a significant risk factor that predisposes patients to complications ( 17 , 18 ). In addition, the larger the diameter of the tumor, the greater the probability that the tumor will invade the surrounding blood vessels, and the higher the chance of the patient's combined vascular resection and the more intraoperative blood loss ( 8 , 19 , 20 ). Moreover, intraoperative blood loss and combined vascular resection had been proved to be risk factors for post-PD complications.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A newly improved POSSUM scoring system for prediction of morbidity in patients with pancreaticoduodenectomy

Zhang¹,

Chen²,

Li³

et al. 2020

Transl Cancer Res TCR

View full text Add to dashboard Cite

Background: Postoperative morbidity of pancreaticoduodenectomy (PD) is still prevalent in hospitals around the world all over the world. Chirurgia B and Chen Yingtai et al. compared the existing POSSUM and p-POSSUM scoring system in pancreatoduodenectomy. However, in this retrospective cohort study our aim was to investigate the risk factors associated with post-PD complications, and develop a POSSUM scoring system more specific to PD, which we define as PD-POSSUM. Methods: Data was gathered from 201 patients who underwent PD procedure at No.4 Hospital of Hebei Medical University between January 2016 and December 2018. All 201 patients were included in the modeling group. The morbidity and associated risk factors were collected and analyzed. The risk factors of complication were investigated by the Pearson χ 2 test, Spearman rho test, multivariable linear regression, univariate/multivariate logistic regression. In addition, the discriminating ability of the PD-POSSUM system to predict morbidity is estimated by the area under the receiver operating characteristic curve (ROC-AUC). Results: Morbidity was 45.5% for the 201 patients. Multivariate logistic regression analysis demonstrated a significant connection between postoperative complications and body mass index (BMI) [odd ratio (OR):

show abstract

Section: Discussionmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 99%

A newly improved POSSUM scoring system for prediction of morbidity in patients with pancreaticoduodenectomy

Zhang¹,

Chen²,

Li³

et al. 2020

Transl Cancer Res TCR

View full text Add to dashboard Cite

show abstract

“…Recent studies have demonstrated that postoperative fluid collections (PFCs), detected by computed tomography (CT) scans, can predict the likelihood of developing POPF after DP 11,12 . However, several studies have also demonstrated that PFCs can be asymptomatic 13–15 . A consensus on the optimal means of integrating PFC assessment into clinical practice is lacking.…”

Section: Introductionmentioning

confidence: 99%

“… 11 , 12 However, several studies have also demonstrated that PFCs can be asymptomatic. 13 , 14 , 15 A consensus on the optimal means of integrating PFC assessment into clinical practice is lacking. Moreover, the presence of PFCs does not necessarily indicate POPF occurrence, as other factors, such as focal ascites or lymphatic leakage, may contribute to PFC.…”

Section: Introductionmentioning

confidence: 99%

Assessing Intra‐abdominal status for clinically relevant postoperative pancreatic fistula based on postoperative fluid collection and drain amylase levels after distal pancreatectomy

Mukai,

Asukai,

Akita

et al. 2023

Annals of Gastroent Surgery

View full text Add to dashboard Cite

AimThe aim of this study was to evaluate the intra‐abdominal status related to postoperative pancreatic fistula by combining postoperative fluid collection and drain amylase levels.MethodsWe retrospectively reviewed the data of 203 patients who underwent distal pancreatectomy and classified their postoperative abdominal status into four groups based on postoperative fluid collection size and drain amylase levels. We also evaluated the incidence of clinically relevant postoperative pancreatic fistula in each group according to C‐reactive protein values.ResultsThe incidence of clinically relevant postoperative pancreatic fistula in the entire cohort (n = 203) was 28.1%. Multivariate analysis revealed that postoperative fluid collection, drain amylase levels, and C‐reactive protein levels are considerable risk factors for clinically relevant postoperative pancreatic fistula. In the subgroup with large postoperative fluid collection and high drain amylase levels, 65.9% of patients developed clinically relevant postoperative pancreatic fistula. However, no significant difference was observed in C‐reactive protein levels between patients with clinically relevant postoperative pancreatic fistula and those without it. In contrast, in the subgroup with a large postoperative fluid collection size or a high amylase level alone, a significant difference was observed in C‐reactive protein values between the patients with clinically relevant postoperative pancreatic fistula and those without it.ConclusionPostoperative fluid collection status and the C‐reactive protein value provide a more precise assessment of intra=abdominal status related to postoperative pancreatic fistula after distal pancreatectomy. This detailed analysis may be a clinically reasonable approach to individual drain management.

show abstract

“…Postoperative intra-abdominal collections (IC) are a frequent entity and could be related to postoperative complications such as anastomotic leaks (pancreatic fistula, bile leak, gastrojejunal leak), infected haematoma or undetermined intra-abdominal abscess. However, an ongoing debate exists regarding the clinical implications of postoperative intra-abdominal collections, as studies have either associated them with non-relevant complications or found no complications [ 4 ]. In the literature, ICs are not systematically reported as a separate entity, making it difficult to determine the true incidence of ICs after PD.…”

Section: Introductionmentioning

confidence: 99%

The role of clinically relevant intra-abdominal collections after pancreaticoduodenectomy

Lopez,

Pando,

Ortega-Torrecilla

et al. 2023

Langenbecks Arch Surg

View full text Add to dashboard Cite

Background There is controversial evidence regarding the impact of clinically relevant postoperative intra-abdominal collections (CR-IC) on the clinical course after pancreaticoduodenectomy. C-reactive Protein (CRP) has been validated as a predictor of postoperative pancreatic fistula (POPF). Still, its role in predicting CR-IC has not been studied. Methods A retrospective analysis was conducted on patients who underwent PD at a tertiary hospital between October 2012 and October 2017. The incidence of CR-IC, clinically relevant POPF and other complications, as well as mortality and length of hospitalisation, was retrieved. The impact of CR-IR on mortality and major complications was analysed. The serum CRP levels were retrieved on the third and fifth postoperative days (POD3 and POD5), followed by an analysis of sensitivity, specificity, and area under the curve to predict CR-IC using CRP. Results One hundred forty patients were enrolled following inclusion and exclusion criteria. The mean age was 66.5 years (15–83). The incidence of CR-IC was 33.7% (47), and CR-POPF was 24.3%. Pancreatic duct diameter ≤ 4 mm was identified as a risk factor related to CR-IC occurrence. The group of patients who developed CR-IC after PD exhibited a higher rate of complications Clavien-Dindo ≥ III compared to patients without CR-IC (40.4% vs 7.5%, p < 0.001), as well as other events such as admission to the intensive care unit (25.5% vs 4.3%, p < 0.001), the incidence of CR-POPF (66% vs 3.2%, p < 0.001), prolonged hospital stay (32 vs 13 days, p < 0.001), postoperative haemorrhage (23.4 vs 5.4%, p = 0.002), and delayed gastric empty (38.8% vs 11.8%, p < 0.001) respectively. Logistic regression analysis identified CR-IC related to POPF as a risk factor for Clavien-Dindo > III: OR = 10.6 (95% CI: 3.90–28.7). No differences in mortality were reported between the CR-IC group and non-CR-IC group. CRP at postoperative day 3 (POD3) > 17.55 mg/dl and CRP at postoperative day 5 (POD5) > 13.46 mg/dl were predictors of CR-IC (AUC: 0.731 and AUC:0.821, respectively). Conclusions CR-IC has a significant impact after pancreaticoduodenectomy and is associated with a higher incidence of Clavien-Dindo ≥ III complications. Additionally, CRP levels at POD3 and POD5 play a role in predicting CR-IC. Prospective studies are essential to explore strategies for mitigating the occurrence of CR-IC after PD.

show abstract

Natural history and therapeutic strategies of post-pancreatoduodenectomy abdominal fluid collections

Cited by 8 publications

References 65 publications

A newly improved POSSUM scoring system for prediction of morbidity in patients with pancreaticoduodenectomy

A newly improved POSSUM scoring system for prediction of morbidity in patients with pancreaticoduodenectomy

Assessing Intra‐abdominal status for clinically relevant postoperative pancreatic fistula based on postoperative fluid collection and drain amylase levels after distal pancreatectomy

The role of clinically relevant intra-abdominal collections after pancreaticoduodenectomy

Contact Info

Product

Resources

About