Early Post-Operative Pancreatitis and Systemic Inflammatory Response Assessed by Serum Lipase and IL-6 Predict Pancreatic Fistula

Abstract Background Post-operative pancreatic fistula (POPF) remains a critical complication after pancreatic resection. This prospective pilot study evaluates perioperative markers of pancreatitis and systemic inflammation to predict clinically relevant grade B/C-POPF (CR-POPF). Methods All patients undergoing pancreatic resection from December 2017 to April 2019 were prospectively enrolled. Surgical procedures and outcomes were correlated with perioperative blood markers. ROC analysis was performed to assess their predictive value for CR-POPF. Cut-offs were calculated with the Youden index. Results In total, 70 patients were analysed (43 pancreatoduodenectomies and 27 distal pancreatectomies). In-hospital/90-d mortality and morbidity were 5.7/7.1% (n = 4/n = 5) and 75.7% (n = 53). Major complications (Clavien–Dindo ≥ 3a) occurred in 28 (40.0%) patients, CR-POPF in 20 (28.6%) patients. Serum lipase (cut-off > 51U/L) and IL-6 (> 56.5 ng/l) on POD3 were significant predictors for CR-POPF (AUC = 0.799, 95%-CI 0.686–0.912 and AUC = 0.784, 95%-CI 0.668–0.900; combined AUC = 0.858, 95%-CI 0.758–0.958; all p < 0.001). Patients with both or one factor(s) above cut-off more frequently developed CR-POPF than cases without (100 vs. 50% vs. 7.5%, p < 0.001). This also applied for overall and severe complications (p = 0.013 and p = 0.009). Conclusions Post-operative pancreatitis and inflammatory response are major determinants for development of POPF. A combination of serum lipase and IL-6 on POD3 is a highly significant early predictor of CR-POPF and overall complications, potentially guiding patient management. Clinical trial registration The study protocol was registered at clinicaltrials.gov (NCT04294797)

Download Full-text

Feasibility of Prophylactic Pancreatojejunostomy in Possible High-Risk Patients for Prevention of Pancreatic Fistula during Enucleation or Limited Pancreatic Resection

The American Surgeon ◽

10.1177/000313481808400138 ◽

2018 ◽

Vol 84 (1) ◽

pp. 149-153 ◽

Cited By ~ 1

Author(s):

Takao Ohtsuka ◽

Yasuhisa Mori ◽

Takaaki Fujimoto ◽

Yoshihiro Miyasaka ◽

Kohei Nakata ◽

...

Keyword(s):

High Risk ◽

Pancreatic Fistula ◽

Pancreatic Resection ◽

Medical Records ◽

Operation Time ◽

Postoperative Pancreatic Fistula ◽

Postoperative Hospital Stay ◽

High Risk Patients ◽

Risk Patients ◽

Related Mortality

The aim of this study was to assess the feasibility of prophylactic pancreatojejunostomy after enucleation or limited pancreatic resection regarding the risk of postoperative pancreatic fistula (PF). We retrospectively reviewed the medical records of 32 patients who underwent enucleation or limited pancreatic resection and compared the clinical parameters between patients with ( n = 10) and without ( n = 22) prophylactic pancreatojejunostomy. Prophylactic pancreatojejunostomy was performed in patients with a possible high risk ofPF. No operation-related mortality occurred. Operation time was significantly longer ( P < 0.01) and blood loss significantly greater ( P < 0.01) in patients with pancreatojejunostomy. Overall complications were more frequent ( P = 0.02) and postoperative hospital stay was significantly longer ( P = 0.02) in patients with pancreatojejunostomy. However, other assessed factors including the prevalence of postoperative PF did not differ between groups. In conclusion, prophylactic pancreatojejunostomy is feasible, and its efficacy in preventing PF after enucleation or limited pancreatic resection in high-risk patients will require further study.

Download Full-text

Postoperative pancreatic fistula after pancreatic resection

Bratislava Medical Journal ◽

10.4149/bll_2020_090 ◽

2020 ◽

Vol 121 (08) ◽

pp. 541-546

Author(s):

M. Sabol ◽

R. Donat ◽

D. Dyttert ◽

V. Reken ◽

D. Sintal ◽

...

Keyword(s):

Pancreatic Fistula ◽

Pancreatic Resection ◽

Postoperative Pancreatic Fistula

Download Full-text

Pancreatic fistulae following pancreatic resection. Analysis of causes and prevention methods

Reports of Vinnytsia National Medical University ◽

10.31393/reports-vnmedical-2018-22(4)-11 ◽

2018 ◽

Vol 22 (4) ◽

pp. 640-646

Author(s):

K.G. Valikhnovska

Keyword(s):

Risk Factors ◽

Pancreatic Fistula ◽

Pancreatic Duct ◽

Pancreatic Resection ◽

Pancreatic Head ◽

Preoperative Period ◽

External Drainage ◽

Distal Pancreatic Resection ◽

Glycemic Level ◽

Prevention Methods

The causes of pancreatic fistula were analyzed in 503 patients aged from 22 to 81who underwent pancreaticoduodenectomy for pancreatic and periampullary tumors. The said patients were operated on during the period from 2008 to 2017. The aim of this study is to improve the outcomes of pancreatic resection based on a retrospective analysis of the risk factors of postoperative pancreatic fistulae and the development of a range of measures to prevent the above complication. The influence of factors on the risk of pancreatic fistula was investigated by Pearson method (χ2). The factors contributing to the occurrence of pancreatic fistulae included type of resection (Whipple pancreaticoduodenectomy, pylorus preserving pancreaticoduodenectomy; χ2=8.616,1, p=0.0033, p<0.01), kind of pathology (cancer of the pancreatic head, χ2=7.658,1, p=0.0057, p<0.01), type of pancreaticojejunostomy (invaginative pancreatic duct-jejunostomy; χ2=12.75,1, p<0.001), technique for drainage of the major pancreatic duct (pancreaticojejunostomy on external drainage, χ2=44.01,1, p<0.0001), resection of venous vessels following distal pancreatic resection (χ2=8.350,1, p=0.0039, p<0.01), glycemic level in the preoperative period (P=0.0344,U=15061), the presence of concomitant diseases in patients (χ2=15.62,1, p=0.0001, p<0.001). Preoperative glycemic level and the presence of concomitant diseases in patients are factors that can be influenced to prevent the onset of pancreatic fistula in the postoperative period in patients who are scheduled for pancreatic resection. Prevention of this complication involves the correction of glycemic level and treatment of concomitant pathology in patients in the preoperative period.

Download Full-text

Evaluation of keratoconus progression

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2017-311651 ◽

2018 ◽

Vol 103 (4) ◽

pp. 551-557 ◽

Cited By ~ 6

Author(s):

Mehdi Shajari ◽

Gernot Steinwender ◽

Kim Herrmann ◽

Kate Barbara Kubiak ◽

Ivana Pavlovic ◽

...

Keyword(s):

Logistic Regression ◽

Roc Analysis ◽

Operating Characteristic ◽

Characteristic Curve ◽

Youden Index ◽

Back Surface ◽

Corneal Surface ◽

Maximum Elevation ◽

Index Index ◽

Variance Index

AimTo define variables for the evaluation of keratoconus progression and to determine cut-off values.MethodsIn this retrospective cohort study (2010–2016), 265 eyes of 165 patients diagnosed with keratoconus underwent two Scheimpflug measurements (Pentacam) that took place 1 year apart ±3 months. Variables used for keratoconus detection were evaluated for progression and a correlation analysis was performed. By logistic regression analysis, a keratoconus progression index (KPI) was defined. Receiver-operating characteristic curve (ROC) analysis was performed and Youden Index calculated to determine cut-off values.ResultsVariables used for keratoconus detection showed a weak correlation with each other (eg, correlation r=0.245 between RPImin and Kmax, p<0.001). Therefore, we used parameters that took several variables into consideration (eg, D-index, index of surface variance, index for height asymmetry, KPI). KPI was defined by logistic regression and consisted of a Pachymin coefficient of −0.78 (p=0.001), a maximum elevation of back surface coefficient of 0.27 and coefficient of corneal curvature at the zone 3 mm away from the thinnest point on the posterior corneal surface of −12.44 (both p<0.001). The two variables with the highest Youden Index in the ROC analysis were D-index and KPI: D-index had a cut-off of 0.4175 (70.6% sensitivity) and Youden Index of 0.606. Cut-off for KPI was −0.78196 (84.7% sensitivity) and a Youden Index of 0.747; both 90% specificity.ConclusionsKeratoconus progression should be defined by evaluating parameters that consider several corneal changes; we suggest D-index and KPI to detect progression.

Download Full-text

Abstract 18021: Functional Substrates as the Strongest Predictor of Outcomes in Patients Presenting for Ventricular Arrhythmia Ablation

Circulation ◽

10.1161/circ.132.suppl_3.18021 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Justin Hayase ◽

Yonatan Faiwiszewski ◽

Stephen Vampola ◽

Aron Bender ◽

Gordon Ho ◽

...

Keyword(s):

Ventricular Arrhythmia ◽

Patient Outcomes ◽

Roc Analysis ◽

Youden Index ◽

History Of ◽

Forward Stepwise ◽

Left And Right ◽

Insight Into ◽

Procedural Outcome

Introduction: Recent work has shown that rotor characteristics can distinguish sustained versus non-sustained ventricular fibrillation (VF). However, the significance of functional VF substrates on patient outcomes is not studied. Methods: In 26 consecutive patients presenting for ventricular arrhythmia ablation procedures, 64-electrode basket catheters were inserted into both the left and right ventricles and VF was induced and defibrillated at 11±3 seconds. Computational phase analysis was performed and each VF cycle was characterized as rotor, focal, or disorganized activation. Follow-up data were analyzed for arrhythmia recurrence and compared to rotor stability. Forward stepwise regression analysis incorporating age, history of CHF, history of a-fib, history of prior MI, number of VTs induced, and presence of post-procedure inducible VT was performed to determine the strongest predictor of procedural outcome. Results: Of 26 patients, 19 had sustained VF, and 16 underwent attempted ablation (7 VT, 9 PVC). Optimization of the Youden index for the ROC analysis regarding rotor stability and procedural outcome demonstrated that maximum rotor stability of > 14.5 rotations (corresponding to total rotor prevalence of 71%) provided optimal sensitivity of 85% and specificity of 87% for arrhythmia recurrence. Among these, greater rotor stability was significantly associated with ventricular arrhythmia recurrence (86% versus 11%, p = 0.01) (Table 1), and was the strongest predictor of outcomes. Recurrence was independent of presenting arrhythmia. Conclusions: Functional VF/VT metrics were the strongest predictor of ventricular arrhythmia outcomes compared to traditional predictors in this series of patients. This suggests that functional substrate characteristics may provide added insight into recurrence mechanisms. Whether they may identify a target for future interventions requires further study.

Download Full-text

Mo2023 STEROID EFFECT ON POSTOPERATIVE PANCREATIC FISTULA AFTER PANCREATIC RESECTION

Gastroenterology ◽

10.1016/s0016-5085(20)34637-0 ◽

2020 ◽

Vol 158 (6) ◽

pp. S-1582

Author(s):

Minsang Kim ◽

Michael A. Mederos ◽

Harsh Patel ◽

Vileena Koneru ◽

Daniela Markovic ◽

...

Keyword(s):

Pancreatic Fistula ◽

Pancreatic Resection ◽

Postoperative Pancreatic Fistula

Download Full-text

Is Ultrasound Elastography Useful in Predicting Clinically Relevant Pancreatic Fistula After Pancreatic Resection?

Pancreas ◽

10.1097/mpa.0000000000001685 ◽

2020 ◽

Vol 49 (10) ◽

pp. 1342-1347

Author(s):

Giovanni Marasco ◽

Claudio Ricci ◽

Francesco Buttitta ◽

Elton Dajti ◽

Federico Ravaioli ◽

...

Keyword(s):

Pancreatic Fistula ◽

Pancreatic Resection ◽

Ultrasound Elastography

Download Full-text

Increased Incidence of Pancreatic Fistulas after the Introduction of a Bioabsorbable Staple Line Reinforcement in Distal Pancreatic Resections

The American Surgeon ◽

10.1177/000313480907501020 ◽

2009 ◽

Vol 75 (10) ◽

pp. 954-957 ◽

Cited By ~ 12

Author(s):

Eduardo A. Guzman ◽

Rebecca A Nelson ◽

Joseph Kim ◽

Alessio Pigazzi ◽

Vijay Trisal ◽

...

Keyword(s):

Pancreatic Fistula ◽

Pancreatic Resection ◽

Staple Line ◽

Parenchymal Transection ◽

Staple Line Reinforcement ◽

Distal Pancreatic Resection ◽

Pancreatic Resections ◽

Clinicopathologic Factors ◽

Pancreatic Fistulas ◽

Definition Of

Pancreatic fistula is a major cause of morbidity after distal pancreatic resection. When resections are performed with linear stapling devices, the use of bioabsorbable staple line reinforcement has been suggested to decrease the rate of pancreatic fistula. Our objective was to investigate the incidence of pancreatic fistula when using the Gore Seamguard® staple line reinforcement in stapled distal pancreatic resections. A retrospective review of 30 consecutive patients with stapled distal pancreatectomy was conducted. A broad definition of pancreatic fistula was used. Clinicopathologic factors and outcomes were compared between groups. Pancreatic fistula was diagnosed in 11 of 15 patients (73%) and three of 15 patients (20%) in the Seamguard® and non-Seamguard® groups, respectively ( P = 0.002). Pancreatic parenchymal transection at the neck of the gland was associated with pancreatic fistula, whereas laparoscopic procedures, splenic preservation, or additional organ resection were not. On multivariate analysis, the association between Seamguard® use and pancreatic fistula was significant ( P = 0.005). In conclusion, after introduction of the Gore Seamguard® bioabsorbable staple line reinforcement, we experienced a significant increase in the rate of pancreatic fistula. This experience raises concern about the efficacy of this device in limiting pancreatic fistula after stapled distal pancreatic resection.

Download Full-text