Multivariate logistic regression analysis for prediction of clinically relevant pancreatic fistula in the early phase after pancreaticoduodenectomy

Abstract

White blood cell count, CRP and d-amylase on POD4 were predictive factors for clinically relevant PF after PD. These findings indicate that our formula is useful for management of drain after PD.

Pathologic Assessment of Pancreatic Fibrosis for Objective Prediction of Pancreatic Fistula and Management of Prophylactic Drain Removal After Pancreaticoduodenectomy

“…Recent studies proposed CRP of 15. [26] and 9.3 mg/dL [27] on POD 4 as cutoff values for clinically relevant PF. CRP is influenced by inflammatory reactions other than PF.…”

Role of C-Reactive Protein Assessment as Early Predictor of Surgical Site Infections Development after Pancreaticoduodenectomy

“…In this regard, CRP appears in our experience to be a helpful tool in clinical practice, even if its use should be rationalized, since CRP predictive power for septic complications is not uniform during the overall postoperative course [22,23,25]. In the first 2 postoperative days, the physiologic response to surgical stress hides the effects on CRP levels of an ongoing septic process, making its assay useless and, moreover, generating a small but unjustified extra cost.…”

“…In recent years, there has been extensive debate about the identification of reliable criteria for POPF prediction after PD; different scores were proposed considering multiple combinations of clinical data, laboratory assays, pancreatic morphology details and often concentrating on preoperative risk factors [25,26,27,28,29,39]: the rationale was to obtain a dependable method, capable of classifying patients into high or low risk groups. Several authors focused on high grade or clinically significant pancreatic fistula (ISGPF B-C) [22], as this complication radically differs from indolent pancreatic fistula.…”

“…With regards to POPF occurrence, several authors focused on the search for a combination of variables, using both laboratory and clinical data, such as body temperature or drainage fluid appearance. These were statistically combined in different arrangements with the aim of identifying a predictor for high grade POPF [25,26,27,28,29]; these models are often complex and require integration of several parameters, making their application poorly convenient in everyday use.…”

Systematic review and meta-analysis of pancreatic amylase value on postoperative day 1 after pancreatic resection to predict postoperative pancreatic fistula

“…[1][2][3][4][5][6][7] Given the frequency and severity of POPF, most surgeons today choose to place intraperitoneal drains with the aim of controlling anastomotic leakage. [8][9][10][11][12] However, drain is a double-edged sword which may increase the risk of infection and the potential damage that may be induced by negative suction and erosion. To date, randomized controlled studies have provided compelling evidence that early drain removal (postoperative day (POD) 3 to 4) develops fewer complications when compared with late drain removal (POD >5).…”