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

Wu, Hanxue; Gao, Xu; Zhao, Yaling; Xue, Feng; Dong, Shunbin; Han, Liang; Wang, Zheng; Wu, Zheng

doi:10.3389/fsurg.2022.916486

Cited by 8 publications

(10 citation statements)

References 48 publications

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“…In our study, out of 78 patients with CR-PPAP, 77 were also diagnosed with CR-POPF. These results support the hypothesis of a possible physio-pathological connection between PPAP and POPF, although both complications may occur independently [26,27]. There is no clear explanation in the literature for the cause-and-effect mechanism between CR-PPAP and CR-POPF.…”

Section: Discussionsupporting

confidence: 83%

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: 83%

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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“…Results of our multifactorial analysis in some of the included studies showed that being a woman as well as having a small pancreatic duct diameter, soft pancreatic texture, and high body mass index (BMI) were all risk factors of POAP after PD ( 14 , 16 , 17 , 26 ).…”

Section: Resultsmentioning

confidence: 99%

“…Regardless of the diagnostic criteria, the high incidence of POAP deserves the attention of surgeons. In particular, the activation of pancreatic enzymes after POAP may lead to prolonged healing time or even non-healing of the pancreatic-intestinal anastomoses, resulting in postoperative pancreatic fistulas (POPFs), localized fluid accumulation in the abdominal cavity, infections, and even serious systemic complications ( 8 , 9 , 14 , 35 , 36 ). Some POAP may include acute necrotizing pancreatitis, which may pose serious hazards and even require secondary surgery for total pancreatectomy ( 10 ).…”

Section: Discussionmentioning

confidence: 99%

“…Some studies have suggested that the risk factors for acute pancreatitis after pancreatic resection include being a woman, not having received neoadjuvant therapy, and the presence of a soft pancreatic texture, a small main pancreatic duct diameter, or high C-reactive protein levels ( 14 , 16 , 17 , 26 , 37 ). We only included sex and the pancreatic texture as variables for our meta-analysis due to the small number of studies analyzing the other risk factors associated with POAP after PD.…”

Section: Discussionmentioning

confidence: 99%

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Incidence and risk factors of postoperative acute pancreatitis after pancreaticoduodenectomy: a systematic review and meta-analysis

Zong

Zhou

et al. 2023

Front. Surg.

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BackgroundPostoperative acute pancreatitis (POAP) is a specific complication after pancreatectomy. The acute inflammatory response of the residual pancreas may affect the healing of pancreatoenteric anastomoses, leading to postoperative pancreatic fistulas (POPFs), abdominal infections, and even progressive systemic reactions, conditions that negatively affect patients' prognoses and can cause death. However, to the best of our knowledge, no systematic reviews or meta-analytic studies have assessed the incidence and risk factors of POAP after pancreaticoduodenectomy (PD).MethodWe searched PubMed, Web of Science, Embase, and Cochrane Library databases for relevant literature describing the outcomes of POAP after PD until November 25, 2022, and we used the Newcastle–Ottawa Scale to assess the quality of the studies. Next, we pooled the incidence of POAP and the odds ratios (ORs) and 95% confidence intervals (CIs) of the risk factors using a random-effect meta-analysis. I2 tests were used to assess heterogeneity between the studies.ResultsWe analyzed data from 7,164 patients after PD from 23 articles that met the inclusion criteria for this study. The subgroup results of the meta-analysis by different POAP diagnostic criteria showed that the incidences of POAP were 15% (95% CI, 5–38) in the International Study Group for Pancreatic Surgery group, 51% (95% CI, 42–60) in the Connor group, 7% (95% CI, 2–24) in the Atlanta group, and 5% (95% CI, 2–14) in the unclear group. Being a woman [OR (1.37, 95% CI, 1.06–1.77)] or having a soft pancreatic texture [OR (2.56, 95% CI, 1.70–3.86)] were risk factors of POAP after PD.ConclusionThe results showed that POAP was common after PD, and its incidence varied widely according to different definitions. Large-scale reports are still needed, and surgeons should remain aware of this complication.Systematic Review Registrationidentifier: CRD42022375124.

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“…Due to its freshness, only one study could be identified assessing the risk factors for ISGPS defined PPAP, identifying soft pancreatic texture and postoperative C-reactive protein over 180 mg/l as independent risk factors. 68 However, there is a growing body of evidence for factors associated with POAP. 9,69 POAP and POPF seem to share the majority of identified risk factors with pancreatic texture, high BMI, narrow duct, operative complexity, non-malignant histology, and male sex predisposing for POAP.…”

Section: Prediction Of Postoperative Pancreatitismentioning

confidence: 99%

Prediction of postoperative pancreatic fistula and pancreatitis after pancreatoduodenectomy or distal pancreatectomy: A review

Bonsdorff

Sallinen

2023

Scand J Surg

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Background and objective: Postoperative pancreatic fistula (POPF) is the leading cause of morbidity and early mortality in patients undergoing pancreatic resection. In addition, recent studies have identified postoperative acute pancreatitis (POAP) as an independent contributor to morbidity. Most perioperative mitigation strategies experimented for POPF have been shown to be in vain with no consensus on the best perioperative management. Clinical prediction models have been developed with the hope of identifying high POPF risk patients with the leading idea of finding subpopulations possibly benefiting from pre-existing or novel mitigation strategies. The aim of this review was to map out the existing prediction modeling studies to better understand the current stage of POPF prediction modeling, and the methodology behind them. Methods: A narrative review of the existing POPF prediction model studies was performed. Studies published before September 2022 were included. Results: While the number of POPF prediction models for pancreatoduodenectomy has increased, none of the currently existing models stand out from the crowd. For distal pancreatectomy, two unique POPF prediction models exist, but due to their freshness, no further external validation or adoption in clinics or research has been reported. There seems to be a lack of adherence to correct methodology or reporting guidelines in most of the studies, which has rendered external validity—if assessed—low. Few of the most recent studies have demonstrated preoperative assessment of pancreatic aspects from computed tomography (CT) scans to provide relatively strong predictors of POPF. Conclusions: Main goal for the future would be to reach a consensus on the most important POPF predictors and prediction model. At their current state, few models have demonstrated adequate transportability and generalizability to be up to the task. Better understanding of POPF pathophysiology and the possible driving force of acute inflammation and POAP might be required before such a prediction model can be accessed.

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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

Cited by 8 publications

References 48 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

Incidence and risk factors of postoperative acute pancreatitis after pancreaticoduodenectomy: a systematic review and meta-analysis

Prediction of postoperative pancreatic fistula and pancreatitis after pancreatoduodenectomy or distal pancreatectomy: A review

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