Predictors of Postoperative Non-Chylous Massive Discharge after Pancreaticoduodenectomy for Pancreatic Ductal Adenocarcinoma

Ito, Kyoji; Kawaguchi, Yoshikuni; Sakamoto, Yoshihiro; Arita, Junichi; Hasegawa, Kiyoshi; Kokudo, Norihiro

doi:10.1159/000479341

Cited by 2 publications

(6 citation statements)

References 22 publications

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“…The early detection of CR-CL helps shorten the postoperative hospital stay and reduce medical costs, as conservative treatment is effective [11,28]. In addition, as in previous studies [13,14], we also showed that a high DOV was associated with significant protein loss. This protein loss causes a decrease in the plasma osmolality and may increase transudative ascites, creating a vicious cycle that may increase the DOV.…”

Section: Discussionsupporting

confidence: 80%

“…In addition to the above, we newly showed that a low DOV on POD 1 (< 227 ml) was a potential postoperative warning sign of CR-POPF. Ito et al reported that the CR-POPF was significantly lower in patients with a high DOV (DOV > 10 ml/kg/day) than in those with a low DOV (DOV ≤ 10 ml/kg/day) after PD for pancreatic ductal adenocarcinoma, but the cut-off value was not evaluated [14]. An increased DOV dilutes the amylase concentration in the drainage output, which reduces the development of POPF and the consequent infection rate [14,22].…”

Section: Discussionmentioning

confidence: 99%

“…Ito et al reported that the CR-POPF was significantly lower in patients with a high DOV (DOV > 10 ml/kg/day) than in those with a low DOV (DOV ≤ 10 ml/kg/day) after PD for pancreatic ductal adenocarcinoma, but the cut-off value was not evaluated [14]. An increased DOV dilutes the amylase concentration in the drainage output, which reduces the development of POPF and the consequent infection rate [14,22]. Alternatively, in patients with a low DOV, the low amount of intra-abdominal ascites may fail to dilute the amylase level, which might increase the incidence of POPF.…”

Section: Discussionmentioning

confidence: 99%

“…The intraoperative variables also included operative time, estimated blood loss, the need for blood transfusion, portal vein or superior mesenteric vein resection, additional organ resection and manipulation of para-aortic LNs. The pathological diagnosis was divided into pancreatic cancer and not pancreatic cancer, as PD for pancreatic cancer sometimes requires extensive LN dissection and superior mesenteric plexus dissection for R0 resection, which can lead to a high DOV after PD [14].…”

Section: Data Acquisitionmentioning

confidence: 99%

“…However, to our knowledge, no reports have comprehensively described the relationship among the DOV after PD and overall complications, major complications and post-pancreatectomy complications, which include POPF [3], delayed gastric emptying (DGE) [10], chyle leak (CL) [11] and post-pancreatectomy hemorrhage (PPH) [12]. Only a few studies have reported that a high DOV is associated with severe dehydration and protein loss, and patients with a high DOV may require a longer hospital stay to manage their massive fluid loss [13,14].…”

Section: Introductionmentioning

confidence: 99%

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Drain output volume after pancreaticoduodenectomy is a useful warning sign for postoperative complications

et al. 2021

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Introduction The drain output volume (DOV) after pancreaticoduodenectomy (PD) is an easily assessable indicator in clinical settings. We explored the utility of the DOV as a possible warning sign of complications after PD. Methods A total of 404 patients undergoing PD were considered for inclusion. The predictability of the DOV for overall morbidity, major complications, intraabdominal infection (IAI), clinically relevant (CR) postoperative pancreatic fistula (POPF), CR delayed gastric emptying (DGE), CR chyle leak (CL), and CR post-pancreatectomy hemorrhaging (PPH) was evaluated. Results One hundred (24.8%) patients developed major complications, and 131 (32.4%) developed IAI. Regarding CR post-pancreatectomy complications, 75 (18.6%) patients developed CR-POPF, 23 (5.7%) developed CR-DGE, 20 (5.0%) developed CR-CL, and 28 (6.9%) developed CR-PPH. The median DOV on postoperative day (POD) 1 and POD 3 was 266 and 234.5 ml, respectively. A low DOV on POD 1 was an independent predictor of CR-POPF, and a high DOV on POD 3 was an independent predictor of CR-CL. A receiver operating characteristics (ROC) analysis revealed that the DOV on POD 1 had a negative predictive value (area under the curve [AUC] 0.655, sensitivity 65.0%, specificity 65.3%, 95% confidence interval [CI]: 0.587–0.724), with a calculated optimal cut-off value of 227 ml. An ROC analysis also revealed that the DOV on POD 3 had a positive predictive value (AUC 0.753, sensitivity 70.1%, specificity 75.0%, 95% CI: 0.651–0.856), with a calculated optimal cut-off value of 332 ml. Conclusion A low DOV on POD 1 might be a postoperative warning sign for CR-POPF, similar to high drain amylase (DA) on POD 1, high DA on POD 3, and high CRP on POD 3. When the DOV on POD 1 after PD was low, surgeons should evaluate the reasons of a low DOV. A high DOV on POD 3 was a postoperative warning sign CR-CL, and might require an appropriate management of protein loss.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Data Acquisitionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Drain output volume after pancreaticoduodenectomy is a useful warning sign for postoperative complications

et al. 2021

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Is 3 weeks a proper time point for the diagnosis of grade B POPF after pancreaticoduodenectomy?

Shen,

Gao,

et al. 2024

International Journal of Surgery Open

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Background: In 2016, the International Study Group of Pancreatic Fistula (ISGPF) improved the definition of postoperative pancreatic fistula (POPF) which defines one of diagnostic criteria for progression of biochemical leak (BL) to grade B fistula as drain for more than 3 weeks. However, we found patients with BL after pancreaticoduodenectomy (PD) or laparoscopic pancreatoduodenectomy (LPD) in our medical center usually progressed to grade B fistula within 3 weeks, which is inconsistent with diagnostic criteria (more than 3 weeks) described in the guidelines. The objective of this study was to investigate the time point at which patients with BL progressed to grade B fistula after PD or LPD. Methods: We selected patients from June 2013 to October 2022 as the research subjects. We used a receiver operating characteristic (ROC) curve to calculate the cutoff value of the time point when BL progressed to grade B fistula. Results: The cutoff value of the time point at which BL progresses to grade B fistula was postoperative day (POD) 9.5. The sensitivity and specificity were 63.6% and 81.4%, respectively. Conclusion: The cutoff value of time point of BL progression to grade B fistula was 9.5, which indicated that we do not need to define grade B fistula as drain for more than 3 weeks. We considered that a too-late time point might delay the timely diagnosis and treatment of grade B fistula and further optimization of the definition of grade B fistula was necessary.

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Predictors of Postoperative Non-Chylous Massive Discharge after Pancreaticoduodenectomy for Pancreatic Ductal Adenocarcinoma

Cited by 2 publications

References 22 publications

Drain output volume after pancreaticoduodenectomy is a useful warning sign for postoperative complications

Drain output volume after pancreaticoduodenectomy is a useful warning sign for postoperative complications

Is 3 weeks a proper time point for the diagnosis of grade B POPF after pancreaticoduodenectomy?

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