Hyperamylasemia and acute pancreatitis after pancreatoduodenectomy: Two different entities

Loos, Martin; Strobel, Oliver; Dietrich, Maximilian; Mehrabi, Arianeb; Ramouz, Ali; Al-Saeedi, Mohammed; Müller‐Stich, Beat P.; Diener, Markus K.; Schneider, Martin; Berchtold, Christoph; Feißt, Manuel; Hinz, Ulf; Mayer, Philipp; Giannakis, Athanasios; Schneider, Daniel; Weigand, Markus; Büchler, Markus W.; Hackert, Thilo

doi:10.1016/j.surg.2020.07.050

Cited by 45 publications

(109 citation statements)

References 13 publications

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“…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 27–31 . 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%

“…Nevertheless, different degrees of radiologic severity of PPAP were documented, ranging from mild pancreatic abnormalities to severe, albeit rare, parenchymal necrosis. Patients with radiologic evidence for PPAP were associated with increased postoperative morbidity 14 . All radiographic abnormalities consistent with PPAP were detected almost exclusively (99% 14 ) in patients with serum amylase values greater than the upper limits of normal 14,15,31 ; 15% of patients with radiologic signs of PPAP after partial pancreatoduodenectomy had serum amylase values greater than the upper limit of normal but less than the Atlanta criteria 25 on POD 1.…”

Section: Resultsmentioning

confidence: 99%

“…[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%

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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%

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Postpancreatectomy Acute Pancreatitis (PPAP)

Marchegiani¹,

Barreto

Bannone³

et al. 2021

Annals of Surgery

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“…A recently described and still controversially discussed situation for a (potentially early) re-operation with remnant pancreatectomy is the occurrence of a severe postoperative remnant pancreatitis, an event occurring in up to 15% of all patients after partial pancreatoduodenectomy. If not managed surgically, this complication leads to a fatal outcome in up to 55% of the patients [53,54].…”

Section: Complication Managementmentioning

confidence: 99%

State-of-the-art surgery for pancreatic cancer

Nießen

Hackert

2021

Langenbecks Arch Surg

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Background The d evelopment of surgical techniques and specialization and specifically complication management in pancreatic surgery have improved surgical outcomes as well as oncological results in pancreatic surgery in recent decades. Historical morbidity and especially mortality rates of up to 80% have decreased to below 5% today. This review summarizes the current state of the art in pancreatic cancer surgery. Methods The present literature and clinical experience are summarized to give an overview of the present best practice in pancreatic surgery as one of the most advanced surgical disciplines today. Results Based on the available literature, three important aspects contribute to best patient care in pancreatic surgery, namely, surgical progress, interdisciplinary complication management, and multimodal oncological treatment in case of pancreatic cancer. In addition, minimally invasive and robotic procedures are currently fields of development and specific topics of research. Conclusion In experienced hands, pancreatic surgery—despite being one of the most challenging fields of surgery—is a safe domain today. The impact of multimodal, especially adjuvant, therapy for oncological indications is well established and evidence-based. New technologies are evolving and will be evaluated with high-evidence studies in the near future.

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“…life threatening and lead to major morbidity and mortality [1]. The most common complication after pancreatic surgery is peripancreatic fluid collection (PFC), which has been reported in up to 50% of cases [1][2][3]. PFC is caused by post-operative pancreatic leakage and occurs more often following central and distal pancreatectomy than following pancreaticoduodenectomy [2,[4][5][6][7].…”

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confidence: 99%

Systematic review and meta-analysis of endoscopic ultrasound drainage for the management of fluid collections after pancreas surgery

et al. 2022

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Background The outcomes of endoscopic ultrasonography-guided drainage (EUSD) in treatment of pancreas fluid collection (PFC) after pancreas surgeries have not been evaluated systematically. The current systematic review and meta-analysis aim to evaluate the outcomes of EUSD in patients with PFC after pancreas surgery and compare it with percutaneous drainage (PCD). Methods PubMed and Web of Science databases were searched for studies reporting outcomes EUSD in treatment of PFC after pancreas surgeries, from their inception until January 2022. Two meta-analyses were performed: (A) a systematic review and single-arm meta-analysis of EUSD (meta-analysis A) and (B) two-arm meta-analysis comparing the outcomes of EUSD and PCD (meta-analysis B). Pooled proportion of the outcomes in meta-analysis A as well as odds ratio (OR) and mean difference (MD) in meta-analysis B was calculated to determine the technical and clinical success rates, complications rate, hospital stay, and recurrence rate. ROBINS-I tool was used to assess the risk of bias. Results The literature search retrieved 610 articles, 25 of which were eligible for inclusion. Included clinical studies comprised reports on 695 patients. Twenty-five studies (477 patients) were included in meta-analysis A and eight studies (356 patients) were included in meta-analysis B. In meta-analysis A, the technical and clinical success rates of EUSD were 94% and 87%, respectively, with post-procedural complications of 14% and recurrence rates of 9%. Meta-analysis B showed comparable technical and clinical success rates as well as complications rates between EUSD and PCD. EUSD showed significantly shorter duration of hospital stay compared to that of patients treated with PCD. Conclusion EUSD seems to be associated with high technical and clinical success rates, with low rates of procedure-related complications. Although EUSD leads to shorter hospital stay compared to PCD, the certainty of evidence was low in this regard.

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Hyperamylasemia and acute pancreatitis after pancreatoduodenectomy: Two different entities

Cited by 45 publications

References 13 publications

Postpancreatectomy Acute Pancreatitis (PPAP)

Postpancreatectomy Acute Pancreatitis (PPAP)

State-of-the-art surgery for pancreatic cancer

Systematic review and meta-analysis of endoscopic ultrasound drainage for the management of fluid collections after pancreas surgery

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