Clinical significance of postoperative acute pancreatitis after pancreatoduodenectomy and distal pancreatectomy

Ikenaga, Naoki; Ohtsuka, Takao; Nakata, Kohei; Watanabe, Yusuke; Mori, Yasuhisa; Nakamura, Masafumi

doi:10.1016/j.surg.2020.06.040

Cited by 38 publications

(68 citation statements)

References 17 publications

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“…We speculate that enzyme‐rich fluid collection injures the surrounding tissues and causes CAPF. In addition, it was recently reported that postoperative acute pancreatitis after PR is associated with POPF 15,16 …”

Section: Discussionmentioning

confidence: 99%

“…Several studies have also reported that amylase values in drainage fluid in the early postoperative days are useful for predicting clinically relevant POPF after PR 12–14 . Additionally, postoperative acute pancreatitis after PR has recently been recognized as a specific complication of pancreatic resection 15,16 . In 2016, Connor proposed a definition of postoperative acute pancreatitis after PR as an increase in serum amylase activity greater than the upper limit of the normal range of serum amylase activity on postoperative day (POD) 1 15 .…”

Section: Introductionmentioning

confidence: 99%

“…The author also suggested postoperative acute pancreatitis can occur immediately after PR and cause pancreatic necrosis, resulting in the development of a POPF. Since then, the clinical significance of postoperative pancreatitis and its relevance to POPF have received much attention 16 …”

Section: Introductionmentioning

confidence: 99%

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Serum pancreatic enzymes in the early postoperative period predict complications associated with pancreatic fluid after pancreas transplantation: A retrospective, single‐center, observational cohort study

Tomihara

Hisadome

Noguchi

et al. 2021

J Hepato Biliary Pancreat

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Background Pancreas transplantation (PT) is a radical treatment for diabetes mellitus (DM). Although the results of PT have been improving, surgical complications remain. Few reports have focused on complications associated with pancreatic fluid (CAPF) after PT. We aimed to investigate the risk factors and predictors for CAPF after PT. Methods Sixty‐nine patients, who underwent deceased‐donor PT for type 1 DM at our institution from August 2001 to May 2020, were retrospectively studied. We identified CAPF from those with Clavien‐Dindo Classification ≥grade III and assessed risk factors by univariate and multivariate analyses using logistic regression. Results Twenty‐one (30.4%) patients had complications with Clavien‐Dindo Classification ≥grade III. Eleven (16.0%) patients were diagnosed with CAPF. Median serum pancreatic amylase (P‐AMY) levels with CAPF on postoperative day (POD)1 and POD2 were significantly higher than those without CAPF (P = .019 and P = .027, respectively). In multivariable analysis, serum P‐AMY levels on POD1 were an independent predictive factor for CAPF (odds ratio 1.83, 95% confidence interval 1.07‐3.14, P = .008). Conclusions Complications associated with pancreatic fluid after PT is associated with high serum P‐AMY in the early postoperative period. Serum pancreatic enzymes in the first few postoperative days after PT may be a significant predictive factor for CAPF.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Serum pancreatic enzymes in the early postoperative period predict complications associated with pancreatic fluid after pancreas transplantation: A retrospective, single‐center, observational cohort study

Tomihara

Hisadome

Noguchi

et al. 2021

J Hepato Biliary Pancreat

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“…Subsequent studies using the Conor definition of PPAP resulted in conflicting findings 14,15,18,31 . 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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confidence: 99%

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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“…Kühlbrey et al suggested that systemic hyperamylasemia detected on postoperative day 1 after pancreas surgery may be a good predictor for future development of clinically relevant POPFs 29 . Other studies also noted that an increase in serum amylase or lipase was possible markers for postoperative acute pancreatitis and suggested a clinical relationship between postoperative acute pancreatitis and POPF 30‐32 . Postoperative serum amylase and lipase were elevated in all 4 DAP cases, as is typical following pancreas transplantation, but with a downward trend in all cases.…”

Section: Discussionmentioning

confidence: 98%

Distal allograft pancreatectomy for graft salvage after pancreas transplantation

Soma

Nikumbh

Mangus

et al. 2021

Clinical Transplantation

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Early pancreas allograft failure most commonly results from vascular thrombosis. Immediate surgical intervention may permit pancreas allograft salvage, typically requiring thrombectomy. In cases of partial allograft necrosis secondary to splenic arterial thrombosis, distal allograft pancreatectomy may allow salvage of at least half of the pancreas allograft with retention of function. We retrospectively reviewed four cases of simultaneous pancreas and kidney recipients who required distal allograft pancreatectomy for splenic artery thrombosis with necrosis of the distal pancreas. Three of the four maintained long‐term allograft function with euglycemia independent of insulin at six months to six years of follow‐up, and all patients continue to maintain normal renal allograft function. Early diagnosis and early intervention are essential in order to salvage the pancreas allograft in the case of thrombosis. Distal allograft pancreatectomy can be performed safely and result in excellent long‐term outcomes in select patients.

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Clinical significance of postoperative acute pancreatitis after pancreatoduodenectomy and distal pancreatectomy

Cited by 38 publications

References 17 publications

Serum pancreatic enzymes in the early postoperative period predict complications associated with pancreatic fluid after pancreas transplantation: A retrospective, single‐center, observational cohort study

Serum pancreatic enzymes in the early postoperative period predict complications associated with pancreatic fluid after pancreas transplantation: A retrospective, single‐center, observational cohort study

Postpancreatectomy Acute Pancreatitis (PPAP)

Distal allograft pancreatectomy for graft salvage after pancreas transplantation

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