Postoperative acute pancreatitis is a serious but rare complication after distal pancreatectomy

Loos, Martin; Strobel, Oliver; Mehrabi, Arianeb; Mihaljevic, André L.; Ramouz, Ali; Dietrich, Maximilian; Müller‐Stich, Beat P.; Schneider, Martin; Berchtold, Christoph; Al-Saeedi, Mohammed; Feißt, Manuel; Hinz, Ulf; Schwab, Constantin; Winterfeld, Moritz von; Mayer, Philipp; Giannakis, Athanasios; Weigand, Markus A.; Hackert, Thilo; Büchler, Markus W.

doi:10.1016/j.hpb.2021.01.004

Cited by 12 publications

(36 citation statements)

References 23 publications

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“…[27][28][29][30][31] When mentioned, the Modified CT Severity Index 53 for AP was the most frequently reported method. 14,15,31 Moreover, there was no consensus on the appropriate timing of axial imaging, which differed between studies. Thus, the ability to see evidence of pancreatic inflammation on CTs varied tremendously.…”

Section: Resultsmentioning

confidence: 99%

“…First, postoperative computed tomography (CT) was not performed in all patients believed to have (or not have) PPAP due to the retrospective design of most series, and the grading system used to score the severity of PPAP was not always reported. [27][28][29][30][31] When mentioned, the Modified CT Severity Index 53 for AP was the most frequently reported method. 14,15,31 Moreover, there was no consensus on the appropriate timing of axial imaging, which differed between studies.…”

Section: Resultsmentioning

confidence: 99%

“…The evidence of PPAP after distal pancreatectomy still is limited. 13,17,23,31,41 According to the best evidence acquired so far, PPAP has been reported as a severe but less frequent complication than after partial pancreatoduodenectomy. 31 A radiologically confirmed PPAP (Fig.…”

Section: Distal (Left-sided) Pancreatectomymentioning

confidence: 99%

“…Differences in the incidence of PPAP were also reported between partial pancreatoduodenectomy 13,14,17 and distal (left-sided) pancreatectomy 17,23 . Not all patients with increased serum pancreatic enzyme activity have shown radiologic alterations or indeed postoperative morbidity related to an AP process, precluding a reliable grading system of the severity of PPAP 14,31 …”

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Postpancreatectomy Acute Pancreatitis (PPAP)

Marchegiani¹,

Barreto

Bannone³

et al. 2021

Annals of Surgery

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Objective:The ISGPS aimed to develop a universally accepted definition for PPAP for standardized reporting and outcome comparison.Background: :PPAP is an increasingly recognized complication after partial pancreatic resections, but its incidence and clinical impact, and even its existence are variable because an internationally accepted consensus definition and grading system are lacking.Methods:The ISGPS developed a consensus definition and grading of PPAP with its members after an evidence review and after a series of discussions and multiple revisions from April 2020 to May 2021.Results:We defined PPAP as an acute inflammatory condition of the pancreatic remnant beginning within the first 3 postoperative days after a partial pancreatic resection. The diagnosis requires (1) a sustained postoperative serum hyperamylasemia (POH) greater than the institutional upper limit of normal for at least the first 48 hours postoperatively, (2) associated with clinically relevant features, and (3) radiologic alterations consistent with PPAP. Three different PPAP grades were defined based on the clinical impact: (1) grade postoperative hyperamylasemia, biochemical changes only; (2) grade B, mild or moderate complications; and (3) grade C, severe life-threatening complications.Discussions:The present definition and grading scale of PPAP, based on biochemical, radiologic, and clinical criteria, are instrumental for a better understanding of PPAP and the spectrum of postoperative complications related to this emerging entity. The current terminology will serve as a reference point for standard assessment and lend itself to developing specific treatments and prevention strategies.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Distal (Left-sided) Pancreatectomymentioning

confidence: 99%

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Postpancreatectomy Acute Pancreatitis (PPAP)

Marchegiani¹,

Barreto

Bannone³

et al. 2021

Annals of Surgery

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“…Early postoperative CT scans were helpful to evaluate the recovery in the surgical field. The remnant pancreas (pancreatic body and tail) was not conventionally dissected during PD procedure; however, the signs of pancreatic exudation or parenchymal changes in postoperative CT scans suggest the formation of PPAP ( 34 ). Palumbo et al ( 35 ) suggested that the routinely postoperative CT scan after laparoscopic sleeve gastrectomy was helpful to early stratification of leakage risk.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors and Clinical Impacts of Post-Pancreatectomy Acute Pancreatitis After Pancreaticoduodenectomy: A Single-Center Retrospective Analysis of 298 Patients Based on the ISGPS Definition and Grading System

Gao

Zhao

et al. 2022

Front. Surg.

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BackgroundThe definition and grading system of post-pancreatectomy acute pancreatitis (PPAP) has recently been proposed by ISGPS. This study aimed to put this definition and classification into practice and investigate the potential risk factors and clinical impacts of PPAP.MethodsDemographic and perioperative data of consecutive patients who underwent pancreaticoduodenectomy (PD) from January 2019 to July 2021 were collected and analyzed retrospectively. The diagnostic criteria of PPAP published by ISGPS, consisting of biochemical, radiologic, and clinical parameters, were adopted. The risk factors were analyzed by univariate and multivariate analyses.ResultsA total of 298 patients were enrolled in this study, and the total incidence of PPAP was 52.4% (150 patients). Stratified by clinical impacts of PPAP, the incidences of grades B and C PPAP were 48.9% and 3.5%, respectively. PPAP after PD was significantly associated with pancreatic fistula and other unfavorable complications. Soft pancreatic texture (OR 3.0) and CRP ≥ 180 mg/L (OR 3.6) were the independent predictors of PPAP, AUC 0.613. Stratified by the grade of PPAP, soft pancreatic texture (OR 2.7) and CRP ≥ 180 mg/L (OR 3.4) were the independent predictors of grade B PPAP, and soft pancreatic texture (OR 19.3), operation duration >360 min (OR 13.8), and the pancreatic anastomosis by using conventional duct to mucosa methods (OR 10.4) were the independent predictors of grade C PPAP. PPAP complicated with pancreatic fistula significantly increased the severe complications and mortality compared to only PPAP occurrence.ConclusionPPAP was not an uncommon complication after PD and was associated with unfavorable clinical outcomes, especially since it was complicated with pancreatic fistula. Soft pancreatic texture and CRP ≥ 180 mg/L were the independent predictors of PPAP. Higher-volume multicenter and prospective studies are strongly needed.

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