Abstract
Background: Prediction of post-pancreaticoduodenectomy (PD) morbidity is difficult, especially in the early postoperative period when CT (Computed Tomography) scans are not available. Elevated serum amylase and lipase in postoperative day 0 or 1 may be used to define postoperative acute pancreatitis (POAP), but the existing literature does not agree on whether POAP is significantly associated with postoperative pancreatic fistula (POPF). Methods: We analyzed the data obtained from a previously published randomized controlled trial. POAP was defined as elevations in serum amylase above 110 U/L on postoperative day 0 or 1. Clinically relevant POAP (CR-POAP) was defined as elevations in C-reactive protein level (CRP) on postoperative day 2 in those with POAP. Postoperative complications including severe complications (Clavien–Dindo ≥ IIIa), POPF, and clinically relevant POPF (CR-POPF) were analyzed. Results: In 246 patients, POAP did not show significant associations with total postoperative complications (odds ratio (OR) 0.697; 95% CI, 0.360–1.313; p = 0.271), severe complications (OR 0.647; 95% CI, 0.258–1.747; p = 0.367), and CR-POPF (OR 0.998; 95% CI, 0.310–3.886; p = 0.998) in multivariable analysis. Conclusions: In patients undergoing PD, POAP was not significantly associated with postoperative complications including POPF. Caution should be taken when using POAP as a predictor of POPF.
Highlights
Pancreaticoduodenectomy (PD) is the mainstay curative treatment for a variety of periampullary diseases [1] but has a rather high postoperative complication rate because of the soft and friable texture of the pancreas and complexity of the procedure
Table S6) in univariable and multivariable analyses. In this secondary data analysis from a single-institution randomized controlled trial, postoperative acute pancreatitis (POAP) and Clinically relevant POAP (CR-POAP) did not show any significant association with the rate of total postoperative complication, severe complication, or CR-postoperative pancreatic fistula (POPF)
CR-POAP is defined by both serum lipase levels on postoperative days 0 or 1 and serum C-reactive protein level (CRP) [2], and several studies claimed that CR-POAP is significantly associated with
Summary
Pancreaticoduodenectomy (PD) is the mainstay curative treatment for a variety of periampullary diseases [1] but has a rather high postoperative complication rate because of the soft and friable texture of the pancreas and complexity of the procedure. Connor [2] proposed defining postoperative pancreatitis as the elevation of urinary trypsinogen-2 (UTRP-2) over 50 ug/L at postoperative days 1 and 2, or when UTRP-2 is not available, elevations of serum amylase and lipase over the upper limit of normal range at postoperative days 0 and 1. Using the latter definition, Bannone et al defined the postoperative acute pancreatitis (POAP) and applied it to their retrospective cohort to suggest that POAP is associated with postoperative pancreatic fistula (POPF) and postoperative morbidity [3]. To evaluate the association between POAP and postoperative complications including clinically relevant POPF (CR-POPF)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
