Serum amylase and C-reactive protein in risk stratification of pancreas-specific complications after pancreaticoduodenectomy

Velu, Lavanniya Kumar Palani; McKay, Colin; Carter, C R; McMillan, Donald C.; Jamieson, Nigel B.; Dickson, Euan J.

doi:10.1002/bjs.10098

Cited by 63 publications

(29 citation statements)

References 34 publications

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“…As recent studies reported raised CRPlevels to correlate well with severity of pancreatitis-associatedcomplications in acute pancreatitis and predict complications following pancreatic surgery, serum CRP and serum lipase levels were correlated with onset of cr-POP. 5,[20][21][22][23] A CRP-value of 150 mg/l on POD 2 was determined as a cut-off value for cr-POP in contrary to Connor's recommendation of a CRP-value of 180 mg/l on POD 2 with a higher sensitivity. This might be due to a variable time frame of postoperative blood sampling between institutions.…”

Section: Discussionmentioning

confidence: 96%

Early postoperative pancreatitis following pancreaticoduodenectomy: what is clinically relevant postoperative pancreatitis?

Birgin

Reeg

Téoule

et al. 2019

HPB

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Background/objectives: Postoperative pancreatitis (POP) has recently been shown to be the cause of pancreatic fistula (POPF) following pancreaticoduodenectomy (PD). The aim of the present study was to document the perioperative outcome associated with POP and determine potential risk factors for POP. Methods: Patients undergoing PD between 2009 and 2015 were identified from the prospective data base at a single center. The previous suggested definition of POP by Connor was used. Complications were graded according to the Clavien-Dindo classification and by the grading proposed for POP. Risk factors for POP were analyzed by univariate and multivariate analysis.Results: Of 190 patients, a total of 100 patients (53%) developed POP of whom 22 (12%) and 13 (7%) had grade B and grade C complications, respectively. Elevated serum CRP-levels on postoperative day (POD) 2 and elevated serum lipase on POD 1 were associated with onset of cr-POP. Conclusion:The proposed definition of POP constitutes a valuable tool to assess a serious pancreaticsurgery associated complication. Routine serum CRP and serum lipase levels on the first two postoperative days enable sufficient discrimination of clinically relevant POP.

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Section: Discussionmentioning

confidence: 96%

Early postoperative pancreatitis following pancreaticoduodenectomy: what is clinically relevant postoperative pancreatitis?

Birgin

Reeg

Téoule

et al. 2019

HPB

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“…Using data from POD 3, a drain amylase >750 IU/L, a CRP 200 mg/L and body temperature 37.5 C demonstrated a positive likelihood ratio of 47 and negative likelihood ratio of 0.2 with regard to predicting CR-POPF. Palani Velu et al 25 have published a follow up study to their previous work 15 with regard to POD 0 serum amylase predicting CR-POPF. In this series 25 230 patients underwent PD of whom 54 (24%) developed CR-POPF.…”

Section: Biochemical Evidence For Early Onset Postoperative Pancreatitis Following Pancreatic Resectionmentioning

confidence: 99%

Defining post-operative pancreatitis as a new pancreatic specific complication following pancreatic resection

Connor

2016

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“…While previous evidence has confirmed the detrimental impact of anatomical factors, such as soft pancreatic texture and small Wirsung diameter, on the risk of developing POPF, 6 recent reports highlighted the role that inflammatory changes occurring in the pancreatic stump, the so‐called post‐operative acute pancreatitis (PAP), may have in the development of POPF 7–15 and also suggested that post‐operative serum amylase elevation (SAE) may be an early indicator of PAP occurrence. However, the relation between SAE and PAP has never been validated from a radiological standpoint.…”

Section: Introductionmentioning

confidence: 99%

Serum amylase elevation following pancreatoduodenectomy with pancreatogastrostomy is strongly associated with major complications

Zimmitti

Langella²,

Sega

et al. 2020

ANZ Journal of Surgery

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Background Recent reports suggest that, following pancreatic resection, serum amylase elevation (SAE) may be a surrogate indicator of post‐operative acute pancreatitis (PAP) and predict post‐operative pancreatic fistula (POPF). However, POPF may not account for the majority of complications when pancreatoenteric continuity is restored by pancreatogastrostomy. We aimed to evaluate, among patients undergoing pancreatoduodenectomy with pancreatogastrostomy, the correlation between SAE, radiological changes consistent with PAP and types of post‐operative complications overall and specific for pancreatic surgery. Methods Perioperative data from 102 patients who underwent pancreatoduodenectomy with pancreatogastrostomy at two Italian hospitals (January 2015–January 2017) were retrospectively analysed. SAE was defined as serum amylase more than three times the normal concentration at post‐operative day 1. Post‐operative abdominal computed tomography scan was routinely performed and retrospectively and blindly re‐assessed for findings consistent with PAP. Results Among 102 study patients, overall and major complications and mortality occurred in 68% and 24% and 3% of cases, respectively. POPF and post‐pancreatectomy haemorrhage (PPH) occurred in 12% and 21%, respectively. In 75% of patients developing PPH, it occurred in the absence of POPF. SAE occurred in 36 patients who, compared to 66 non‐SAE patients, more frequently showed computed tomography scan findings consistent with pancreatic stump inflammation (P = 0.002), confirming association between SAE and PAP. SAE was independently associated with the occurrence of major complications, POPF and PPH (hazard ratio (HR) 3.27, P = 0.032; HR 3.94, P = 0.012; HR 12.26, P = 0.002). Conclusion SAE can be considered a valid surrogate of PAP and is strongly associated with a higher rate of post‐operative major complications, both overall and specific for pancreatic resection.

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Serum amylase and C-reactive protein in risk stratification of pancreas-specific complications after pancreaticoduodenectomy

Cited by 63 publications

References 34 publications

Early postoperative pancreatitis following pancreaticoduodenectomy: what is clinically relevant postoperative pancreatitis?

Early postoperative pancreatitis following pancreaticoduodenectomy: what is clinically relevant postoperative pancreatitis?

Defining post-operative pancreatitis as a new pancreatic specific complication following pancreatic resection

Serum amylase elevation following pancreatoduodenectomy with pancreatogastrostomy is strongly associated with major complications

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