Impact of preoperative asymptomatic renal dysfunction on clinical course after pancreatoduodenectomy

Abstract

Background Although recent large-scale clinical studies have shown that preoperative renal insufficiency is associated with increased risk of postoperative complications after pancreatoduodenectomy (PD), it is unknown whether asymptomatic renal dysfunction has an impact on postoperative course after PD. Methods Two hundred and fifty-four patients who underwent PD between 2007 and 2013 were enrolled. Renal function was evaluated by the preoperative estimated glomerular filtration rate (eGFR). Patients were divided into two groups according to the cutoff value of 55 of eGFR. Results Thirty-five patients were classified as the low eGFR group, while 219 were classified as the normal group. There were differences between groups in age, comorbidity and pancreatic texture. The incidence of overall postoperative complication, grade B/C pancreatic fistula and severe complication in the low eGFR group was significantly higher than that in the normal group. Multivariate analysis identified low eGFR as an independent risk factor for severe postoperative complications and grade B/C pancreatic fistula after PD. However, there were no differences in mortality and survival between the low and normal eGFR groups. ConclusionsWe have demonstrated for the first time that preoperative asymptomatic renal dysfunction may be a significant risk factor for severe morbidity and clinically relevant pancreatic fistula after PD.

Dynamic prediction for clinically relevant pancreatic fistula: a novel prediction model for laparoscopic pancreaticoduodenectomy

“…Combining the abovementioned factors, the occurrence of the CR-POPF is probably associated with the high level of inflammation and relatively poor nutritional state of a patient. Moreover, our result showing that a high preoperative creatine level contributes to a higher risk of CR-POPF is support by the finding of a previous study reporting that preoperative asymptomatic renal dysfunction is an independent risk factor for CR-POPF after PD and is associated with increased complications after various of types of surgery [40][41][42][43].…”

High baseline soluble urokinase plasminogen activator receptor (suPAR) serum levels indicate adverse outcome after resection of pancreatic adenocarcinoma

“…Serum creatinine levels are the most established biomarker for the evaluation of renal function but its relevance for the prediction of postoperative AKI is restricted (41). In the context of pancreatic resection, preoperative severe chronic kidney disease (CKD grade IV/V) has been described as a negative prognostic factor (42), but also asymptomatic renal dysfunction which often goes along with unaltered creatinine levels represents a significant risk factor for morbidity after pancreatoduodenectomy (43). Moreover, elevated preoperative suPAR levels were associated with postoperative surgical complications and the necessity of revision surgery after initial tumor resection.…”

Increased Risk of Complications After Pancreatoduodenectomy in Uninephrectomized Patients

“…47 Renal insufficiency has recently been reported to be associated with many postoperative complications. 32 Nagai et al 13 and Are et al 48 reported that preoperative renal insufficiency was associated with post-PD morbidity and mortality. Even small changes in the serum Cre level can portend dramatic increases in patient morbidity and mortality.…”

“…The eGFR that was based on the results from the latest lab exams preceding operation was calculated using the following formulas: eGFR (mL/min per 1.73 m 2 ) ¼ 194 3 serum creatinine À1.094 3 Age À0.287 (30.739; if the patient was female). 13,23 The PNI was calculated as 10 3 serum albumin (g/dL) þ 0.005 3 total lymphocyte count (per mm 3 ). [24][25][26] Written informed consent was obtained from all patients before the operation, according to our institutional guidelines.…”

“…It has also been reported that preoperative asymptomatic renal dysfunction might be a significant risk factor for severe morbidity and clinically relevant pancreatic fistula after PD. 13 On the other hand, we occasionally experience PD in uninephrectomized (UN) patients. According to the Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients, the total number of living donor kidney transplantations has remained flat, and the procedure is performed in more than 5000 cases in the United States each year.…”