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

Abstract

BackgroundThe definition and grading system of post-pancreatectomy acute pancreatitis (PPAP) has recently been proposed by ISGPS. This study aimed to put this definition and classification into practice and investigate the potential risk factors and clinical impacts of PPAP.MethodsDemographic and perioperative data of consecutive patients who underwent pancreaticoduodenectomy (PD) from January 2019 to July 2021 were collected and analyzed retrospectively. The diagnostic criteria of PPAP published by ISGPS, consisting of biochemical, radiologic, and clinical parameters, were adopted. The risk factors were analyzed by univariate and multivariate analyses.ResultsA total of 298 patients were enrolled in this study, and the total incidence of PPAP was 52.4% (150 patients). Stratified by clinical impacts of PPAP, the incidences of grades B and C PPAP were 48.9% and 3.5%, respectively. PPAP after PD was significantly associated with pancreatic fistula and other unfavorable complications. Soft pancreatic texture (OR 3.0) and CRP ≥ 180 mg/L (OR 3.6) were the independent predictors of PPAP, AUC 0.613. Stratified by the grade of PPAP, soft pancreatic texture (OR 2.7) and CRP ≥ 180 mg/L (OR 3.4) were the independent predictors of grade B PPAP, and soft pancreatic texture (OR 19.3), operation duration >360 min (OR 13.8), and the pancreatic anastomosis by using conventional duct to mucosa methods (OR 10.4) were the independent predictors of grade C PPAP. PPAP complicated with pancreatic fistula significantly increased the severe complications and mortality compared to only PPAP occurrence.ConclusionPPAP was not an uncommon complication after PD and was associated with unfavorable clinical outcomes, especially since it was complicated with pancreatic fistula. Soft pancreatic texture and CRP ≥ 180 mg/L were the independent predictors of PPAP. Higher-volume multicenter and prospective studies are strongly needed.

Risk Factors of Postoperative Acute Pancreatitis and Its Impact on the Postoperative Course after Pancreaticoduodenectomy—10 Years of Single-Center Experience

“…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.…”

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

“…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 ).…”

“…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 ).…”

“…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.…”

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

“…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.…”