Postoperative acute pancreatitis after pancreatic resection in patients with pancreatic ductal adenocarcinoma

Murakawa, Masaaki; Kamioka, Yuto; Kawahara, Shinnosuke; Yamamoto, Naoto; Kobayashi, Seiichiro; Ueno, Makoto; Morimoto, Manabu; Ohshima, Takashi; Yukawa, Norio; Rino, Yasushi; Masuda, Munetaka; Morinaga, Soichiro

doi:10.1007/s00423-022-02481-0

Cited by 8 publications

(5 citation statements)

References 27 publications

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“…Because of this discrepancy in PPAP definitions, it is difficult to compare results concerning the occurrence of this complication. Murakawa et al reported a 58.9% occurrence of postoperative pancreatitis after PD, applying Connor's definition of hyperamylasemia on POD0 and1 [20]. In our results, PPAP occurred in 38.5% of patients, with 18.2% of CR-PPAP.…”

Section: Discussionsupporting

confidence: 58%

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

Gajda,

Grudzińska,

Szmigiel

et al. 2023

Life

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Background: Clinically relevant acute postoperative pancreatitis (CR-PPAP) after pancreaticoduodenectomy (PD) is a complication that may lead to the development of local and systemic consequences. The study aimed to identify risk factors for CR-PPAP and assess the impact of CR-PPAP on the postoperative course after PD. Methods: The study retrospectively analyzed data from 428 consecutive patients who underwent PD at a single center between January 2013 and December 2022. The presence of increased amylase activity in plasma, above the upper limit of normal 48 h after surgery, was checked. CR-PPAP was diagnosed when accompanied by disturbing radiological features and/or symptoms requiring treatment. We investigated the relationship between the occurrence of CR-PPAP and the development of postoperative complications after PD, and possible predictors of CR-PPAP. Results: The postoperative follow-up period was 90 days. Of the 428 patients, 18.2% (n = 78) had CR-PPAP. It was associated with increased rates of CR-POPF, delayed gastric emptying, occurrence of intra-abdominal collections, postoperative hemorrhage, peritonitis, and septic shock. Patients who developed CR-PPAP were more often reoperated (37.17% vs. 6.9%, p < 0.0001)) and had increased postoperative mortality (14.1% vs. 5.74%, p < 0.0001). Soft pancreatic parenchyma, intraoperative blood loss, small diameter of the pancreatic duct, and diagnosis of adenocarcinoma papillae Vateri were independent risk factors for CR-PPAP and showed the best performance in predicting CR-PPAP. Conclusions: CR-PPAP is associated with an increased incidence of postoperative complications after PD, worse treatment outcomes, and an increased risk of reoperation and mortality. Pancreatic consistency, intraoperative blood loss, width of the duct of Wirsung, and histopathological diagnosis can be used to assess the risk of CR-PPAP. Amylase activity 48 h after surgery > 161 U/L is highly specific in the diagnosis of CR-PPAP.

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Section: Discussionsupporting

confidence: 58%

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

Gajda,

Grudzińska,

Szmigiel

et al. 2023

Life

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“…In addition, it was noted that NAMPT may increase postoperatively due to the inflammatory changes and increased cellular metabolism, independent of the type of resection performed. In a significant proportion of patients who underwent pancreatic resection, inflammation has been found to play a critical role in the development of POPF [ 51 ]. It has been shown that inflammatory response reduces phosphate levels due to an increased metabolic state, increased cytokine release, inflammatory cell activation, and transcellular shifts, among other causes [ 29 , 50 , 52 ].…”

Section: Discussionmentioning

confidence: 99%

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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“…Recent research has demonstrated the impact of systemic inflammatory factors and nutritional status on cancer prognosis [10]. Examples of such indicators include lymphocytes [11], monocytes [12], neutrophils [13], C-reactive protein (CRP) [14], and albumin levels (ALB) [15], To further improve the accuracy of cancer prognosis prediction, a combination of these biochemical indicators, such as the modified Glasgow Prognostic Score (mGPS) [16],C-reactive protein to albumin ratio [17],and neutrophil-to-lymphocyte ratio (NLR) [18], have been studied. A recent study analyzed the research hotspots in the field of immunonutrition and oncology over the past 25 years, exploring the potential of immunonutrition in cancer prevention, treatment, and improved outcomes [19].…”

Section: Introductionmentioning

confidence: 99%

Prognostic significance of preoperative lymphocytes, albumin, and neutrophils (LANR) index in resectable pancreatic ductal adenocarcinoma

Zhuang,

Wang,

Wang

et al. 2024

BMC Cancer

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Purpose The index composed of preoperative lymphocytes, albumin, and neutrophils (LANR), a new composite score based on inflammatory response and nutritional status, has been reported to be associated with the prognosis of multiple types of cancer, but the role of LANR in the prognosis of resectable pancreatic ductal adenocarcinoma (PDAC) has not yet been elucidated. Patients and methods The data of 142 patients with PDAC who underwent radical resection in the Affiliated Hospital of Jiangnan University from January 2015 to December 2018 were retrospectively analyzed. Receiver Operating Characteristic (ROC) curves were generated to determine the optimal cut-off values for these parameters, as well as the sensitivity and specificity of LANR in predicting survival. The Kaplan–Meier method was used to draw the survival curves. Log rank test was used for univariate analysis, and Cox proportional hazards regression model was used for multivariate analysis. Results The optimal cut-off value of LANR was 18.145, and a low preoperative LANR was significantly correlated with the location of the tumor (p = 0.047). Multivariate analysis showed that tumor differentiation degree (HR:2.357, 95%CI:1.388–4.003,p = 0.002), lymph node metastasis (HR:1.755, 95%CI: 1.115–2.763, p = 0.015), TNM stage (HR:4.686, 95%CI: 2.958–7.425, p < 0.001), preoperative cancer antigen 19 − 9 levels (HR:1.001, 95%CI: 1.000-1.001, p < 0.001) and preoperative LANR (HR:0.221, 95%CI: 0.111–0.441, p < 0.001) were independent risk factors for a poor prognosis in patients undergoing radical resection of PDAC. Conclusion This study found that preoperative LANR can be used to assess the prognosis of radical resection in patients with PDAC; those with low preoperative LANR had a worse outcome.

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Postoperative acute pancreatitis after pancreatic resection in patients with pancreatic ductal adenocarcinoma

Cited by 8 publications

References 27 publications

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

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

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

Prognostic significance of preoperative lymphocytes, albumin, and neutrophils (LANR) index in resectable pancreatic ductal adenocarcinoma

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