Postoperative acute pancreatitis following pancreaticoduodenectomy: a determinant of fistula driven by the intraoperative fluid management

Bannone, Elisa; Andrianello, Stefano; Marchegiani, Giovanni; Masini, Gaia; Malleo, Giuseppe; Bassi, Claudio; Salvia, Roberto

doi:10.1016/j.pan.2018.05.207

Cited by 47 publications

(157 citation statements)

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“…Our results also showed that an elevated serum amylase level on POD 1 was significantly associated with POPF. The mechanism underlying hyperamylasemia in patients with POPF during the early postoperative period after pancreaticoduodenectomy is explained by the finding that postoperative acute pancreatitis, based on elevated serum amylase level on either POD 0 or 1, might be a biochemical manifestation of intraoperative ischemic damage to the pancreatic stump that eventually leads to POPF [38,39]. For this reason, serum amylase level during the early postoperative period may reflect the local inflammatory response to pancreaticojejunostomy after pancreaticoduodenectomy.…”

Section: Discussionmentioning

confidence: 99%

Combined prognostic nutritional index ratio and serum amylase level during the early postoperative period predicts pancreatic fistula following pancreaticoduodenectomy

et al. 2020

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Background: The aim of this study was to investigate the usefulness of the range of change in prognostic nutritional index (PNI) during the early postoperative period as a predictor of postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy. Methods: Data were retrospectively analyzed for 192 patients who underwent pancreaticoduodenectomy. Univariate and multivariate logistic regression analyses were used to evaluate perioperative variables. PNI P3-Pre ratio represented the range of change in PNI from before surgery to postoperative day (POD) 3, PNI P1-Pre ratio represented the range of change in PNI from before surgery to POD 1, and PNI P3-P1 ratio represented the range of change in PNI from POD 1 to POD 3. Results: The area under the curve (AUC) for PNI P3-P1 for prediction of POPF following pancreaticoduodenectomy was 0.683 (P < 0.001), which was highest among PNI ratios and higher than PNI on POD 3. The AUC for serum amylase level on POD 1 was 0.704 (P < 0.001), which was superior to the corresponding AUC on POD 3. The AUC for the combination of PNI P3-P1 ratio and serum amylase level on POD 1 for prediction of POPF was higher than the AUC of either indicator alone (0.743, P < 0.001). The combination of PNI P3-P1 ratio and serum amylase level on POD 1 was an independent predictor of POPF following pancreaticoduodenectomy (P = 0.018). Conclusions: The combination of the range of change in PNI from POD 1 to POD 3 and serum amylase levels on POD 1 may be useful for prediction of POPF following pancreaticoduodenectomy.

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Section: Discussionmentioning

confidence: 99%

Combined prognostic nutritional index ratio and serum amylase level during the early postoperative period predicts pancreatic fistula following pancreaticoduodenectomy

et al. 2020

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“…While previous evidence has confirmed the detrimental impact of anatomical factors, such as soft pancreatic texture and small Wirsung diameter, on the risk of developing POPF, 6 recent reports highlighted the role that inflammatory changes occurring in the pancreatic stump, the so‐called post‐operative acute pancreatitis (PAP), may have in the development of POPF 7–15 and also suggested that post‐operative serum amylase elevation (SAE) may be an early indicator of PAP occurrence. However, the relation between SAE and PAP has never been validated from a radiological standpoint.…”

Section: Introductionmentioning

confidence: 99%

Serum amylase elevation following pancreatoduodenectomy with pancreatogastrostomy is strongly associated with major complications

Zimmitti

Langella²,

Sega

et al. 2020

ANZ Journal of Surgery

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Background Recent reports suggest that, following pancreatic resection, serum amylase elevation (SAE) may be a surrogate indicator of post‐operative acute pancreatitis (PAP) and predict post‐operative pancreatic fistula (POPF). However, POPF may not account for the majority of complications when pancreatoenteric continuity is restored by pancreatogastrostomy. We aimed to evaluate, among patients undergoing pancreatoduodenectomy with pancreatogastrostomy, the correlation between SAE, radiological changes consistent with PAP and types of post‐operative complications overall and specific for pancreatic surgery. Methods Perioperative data from 102 patients who underwent pancreatoduodenectomy with pancreatogastrostomy at two Italian hospitals (January 2015–January 2017) were retrospectively analysed. SAE was defined as serum amylase more than three times the normal concentration at post‐operative day 1. Post‐operative abdominal computed tomography scan was routinely performed and retrospectively and blindly re‐assessed for findings consistent with PAP. Results Among 102 study patients, overall and major complications and mortality occurred in 68% and 24% and 3% of cases, respectively. POPF and post‐pancreatectomy haemorrhage (PPH) occurred in 12% and 21%, respectively. In 75% of patients developing PPH, it occurred in the absence of POPF. SAE occurred in 36 patients who, compared to 66 non‐SAE patients, more frequently showed computed tomography scan findings consistent with pancreatic stump inflammation (P = 0.002), confirming association between SAE and PAP. SAE was independently associated with the occurrence of major complications, POPF and PPH (hazard ratio (HR) 3.27, P = 0.032; HR 3.94, P = 0.012; HR 12.26, P = 0.002). Conclusion SAE can be considered a valid surrogate of PAP and is strongly associated with a higher rate of post‐operative major complications, both overall and specific for pancreatic resection.

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“…However, some retrospective studies not included in the abovementioned meta-analysis [26][27][28] were suggesting an increase in pancreatic fistulas associated with excessive fluid. Moreover, a study from Bannone et al reported an increased incidence of postoperative acute pancreatitis and pancreatic fistula in high-risk patients after pancreatoduodenectomy with an intraoperative fluid administration of ≤ 3 ml/kg/h 29 . In the present study, the median intraoperative fluid administration was 9 ml/kg/h and no increased rate of pancreatic fistula was observed between both groups.…”

Section: Discussionmentioning

confidence: 99%

Perioperative fluids and complications after pancreatoduodenectomy within an enhanced recovery pathway

Gilgien

Halkic

Demartines

et al. 2020

Sci Rep

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Optimized fluid management is a key component of enhanced recovery (ERAS) pathways. Implementation is challenging for pancreatoduodenectomy (PD) and clear guidance is missing in the respective protocol. The aim of this retrospective study was to evaluate the influence of perioperative intravenous (IV) fluid administration on postoperative complications. 164 consecutive patients undergoing PD within ERAS between October 2012 and June 2017 were included. Perioperative IV fluid and morbidity (Clavien classification and comprehensive complication index (CCI)) were assessed. A threshold of more than 4400 ml IV fluid during the first 24 h could be identified to predict occurrence of complications (area under ROC curve 0.71), with a positive and negative predictive value of 93 and 23% respectively. More than 4400 ml intravenous fluids during the first 24 h was an independent predictor of overall postoperative complications (adjusted odds ratio 4.40, 95% CI 1.47–13.19; p value = 0.008). Patients receiving ≥ 4400 ml were associated with increased overall complications (94 vs 77%; p value < 0.001), especially pulmonary complications (31 vs 16%; p value = 0.037), as well as a higher median CCI (33.7 vs 26.2; p value 0.041). This threshold of 4400 ml intravenous fluid might be a useful indicator for the management following pancreatoduodenectomy.

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Postoperative acute pancreatitis following pancreaticoduodenectomy: a determinant of fistula driven by the intraoperative fluid management

Cited by 47 publications

References 0 publications

Combined prognostic nutritional index ratio and serum amylase level during the early postoperative period predicts pancreatic fistula following pancreaticoduodenectomy

Combined prognostic nutritional index ratio and serum amylase level during the early postoperative period predicts pancreatic fistula following pancreaticoduodenectomy

Serum amylase elevation following pancreatoduodenectomy with pancreatogastrostomy is strongly associated with major complications

Perioperative fluids and complications after pancreatoduodenectomy within an enhanced recovery pathway

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