scholarly journals O-P01 Potential Utility of Intraoperative Fluid Amylase Measurement During Pancreaticoduodenectomy

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
K Joshi ◽  
M Abradelo ◽  
N Chatzizacharias ◽  
D Bartlett ◽  
B Dasari ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Risk Score ◽  
Postoperative Pancreatic Fistula ◽  
Low Risk ◽  
Risk Scores ◽  
Pancreatic Anastomosis ◽  
Patient Demographics ◽  
Clinical Risk ◽  
Risk Patients ◽  
Fistula Risk Score

Abstract Background Postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD) is a source of major morbidity and mortality. Early diagnosis and treatment of POPF is mandatory to improve patient outcomes, and clinical risk scores may be combined with postoperative drain fluid amylase (DFA) values to stratify patients. The aim of this study was to determine if intraoperative fluid amylase values (IFA) correlate with DFA1 and POPF. Methods In consecutive patients undergoing PD between February and November 2020, intraoperative samples of intra-abdominal fluid adjacent to the pancreatic anastomosis were taken and sent for fluid amylase measurement prior to abdominal closure. Data regarding patient demographics, postoperative DFA values, complications and mortality were prospectively collected. Results Patient Demographics: Data was obtained for 52 patients with a median alternative Fistula Risk Score (aFRS) of 9.4. Postoperative complications occurred in 20 patients (38%), including five Clavien grade 3+. There were eight POPFs and two patients died (pneumonia/sepsis). There was significant correlation between IFA and DFA1 (Pearson’s correlation: R2=0.713; p < 0.001) and DFA3 (p < 0.001), and median IFA was higher in patients with POPF than patients without (1232.5 vs. 122; p = 0.0003). IFA>260 U/l predicted POPF with sensitivity, specificity, PPV and NPV of 88%, 75%, 39% and 97%, respectively. The incidence of POPF was 43% in high risk (high aFRS/IFA) and 0% in low risk patients (low aFRS/IFA). Complications: Conclusions Intraoperative fluid amylase closely correlated with postoperative pancreatic fistula, and may be a useful adjunct to clinical risk scores to stratify patients during pancreatico-duodenectomy, allowing targeted intervention to reduce the clinical impact of pancreatic fistula.It is possible to detect fluid amylase adjacent to the completed pancreatic anastomosis in patients undergoing PD. Presence of IFA correlates with postoperative DFA and POPF. IFA increases the accuracy of the alternate Fistula Risk Score in predicting POPF. Low risk patients with a low IFA may be suitable for a ‘no drain’ strategy, whilst patients with a high IFA may benefit from intraoperative mitigation strategies to reduce the incidence and/or severity of a postoperative pancreatic fistula.

scholarly journals Retrospective Comparative Analysis of POPF Using Fistula Risk Score According to Pancreaticoenterostomy Method

2021 ◽  
Vol 105 (1-3) ◽  
pp. 559-563
Author(s):  
Seungmin Lee ◽  
Kwang Yeol Paik
Keyword(s):  
High Risk ◽  
Pancreatic Fistula ◽  
Risk Score ◽  
Risk Group ◽  
Risk Groups ◽  
High Risk Group ◽  
Postoperative Pancreatic Fistula ◽  
Clinical Risk Score ◽  
Reconstructive Methods ◽  
Fistula Risk Score

Background The aim of this study is to examine whether pancreaticogastrostomy (PG) or pancreaticojejunostomy (PJ) is the better reconstructive method to reduce postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD) according to the fistula risk. Methods An institutional database was reviewed for patients undergoing PD between January 2008 and August 2019. A total of 159 patients were stratified into 4 groups according to the Clinical Risk Score-Pancreatic Fistula. POPF according to 4 risk groups was compared between PJ and PG. Results Of the 159 patients, 82 underwent PG (51.6%) and 77 underwent PJ (48.4%) reconstruction. POPF rate was 17.1% (n = 14) in the PG group and 12.9% (n = 10) in the PJ group (P = 0.51). POPF rates were not different in intermediate, low, and negligible risks between 2 reconstructive methods. In the high-risk group (n = 47), there were 4 POPFs (22.2%) in PJ group and 9 (31.0%) in the PG group, respectively (P = 0.74). Conclusion In PD, there was no superior method of reconstruction with regard to POPF, even in high-risk glands.

Poor-Risk Acute Leukemia Patients with An EBMT Low-Risk Score and An 8/8 Matched Unrelated Donor Show Excellent Survival After Hematopoietic Stem Cell Transplantation.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 1196-1196
Author(s):  
Tom Lodewyck ◽  
Machteld Oudshoorn ◽  
Bronno van der Holt ◽  
Eefke Petersen ◽  
Eric Spierings ◽  
...  
Keyword(s):  
High Resolution ◽  
Acute Leukemia ◽  
Risk Score ◽  
Low Risk ◽  
Risk Scores ◽  
Unrelated Donor ◽  
Hematopoietic Stem ◽  
Poor Risk ◽  
Risk Patients ◽  
The Impact

Abstract Abstract 1196 Poster Board I-218 Introduction: Allogeneic hematopoietic stem cell transplantation (alloSCT) from volunteer unrelated donors (URD) may be associated with a higher non-relapse mortality (NRM) and worse outcome as compared to alloSCT using HLA-identical sibling donors. However, many parameters next to donor type define NRM. The impact on outcome of allele-matching for HLA-A, -B, -C and -DRB1 between donor and recipient has clearly been demonstrated. The prognostic impact of the EBMT risk score, that takes into account age, stage of disease, time from diagnosis to transplantation, donor type and donor-recipient gender combination, has recently been validated in a variety of hematological malignancies including acute leukemia and myelodysplastic syndrome (MDS). We evaluated the relative prognostic value of high-resolution HLA matching and the EBMT risk score for patients with poor-risk acute leukemia and MDS who received an URD transplant. Patients and methods: Between 1987 and 2006, 327 patients (≥16y) with poor-risk acute leukemia and MDS underwent URD alloSCT in the Netherlands. Patients were in 1st complete remission (CR1, n=129), 2nd CR (CR2, n=91), beyond CR2 or not in remission (n=107). The leukemia-risk was considered to be poor if patients had adverse cytogenetics or were not in CR1. The majority of the grafts was T-cell depleted (94%). High-resolution typing of HLA-A, -B, -C, and -DRB1 alleles was available for analysis in 270 donor-recipient pairs and had in part been performed retrospectively. Results: We evaluated the impact of high-resolution matching for HLA-A, -B, -C and -DRB1 on progression free survival (PFS) and overall survival (OS). Patients who were fully matched (8/8) with their donors (n=170) hadsignificantly superior PFS (40+/-4% vs 26+/-5%, hazard ratio (HR)=0.68; 95%CI 0.50–0.92, p=0.01) and OS (39+/-4% vs 29+/-5%, HR=0.70; 95%CI 0.51-0.96, p=0.03), compared to patients with mismatched (≤7/8) donors (n=100). Superior OS in the 8/8 group appeared to be due to a lower NRM (24+/-4% vs 39+/-5%, HR=0.54; 95%CI 0.35-0.85, p=0.008), while the relapse mortality rate was identical in both groups (37+/-4% vs 32+/-5%). Patients with EBMT risk scores of 1-2 (n=71), 3 (n=77), 4 (n=76) and 5-7 (n=103) had a predicted 5 year OS of 52%, 41% (HR=1.57; 95%CI 0.98-2.52), 29% (HR=2.07; 95%CI 1.32-3.26) and 19% (HR=2.69; 95%CI 1.76-4.11), respectively (p<0.001). Relapse mortality rate and NRM increased with increasing EBMT risk score. As shown in the table, the impact of allele-matching on OS was most evident in the EBMT low-risk group. EBMT low-risk (1-2) patients with 8/8 donors showed excellent 5 year OS compared to EBMT low-risk patients with ≤7/8 donors (73+/-8% vs 35+/-12%). The favorable impact of a fully matched donor was absent in patients with higher EBMT risk scores. Conclusions: Both the EBMT risk score and the degree of allele-matching independently predicted outcome after URD alloSCT. The predictive value of allele-matching was especially evident in EBMT low-risk patients, while patients with the highest EBMT risk scores (>4) had a dismal outcome, despite allele-matching. These results emphasize the importance of incorporating age, disease stage, donor-recipient gender combination and time interval from diagnosis to transplantation (EBMT risk score parameters) as well as high-resolution HLA-typing in the risk assessment prior to URD alloSCT. As excellent OS was noted in well matched EBMT low-risk patients, our data underscore the importance of an immediate search for an unrelated donor in poor-risk leukemia patients in CR1 below the age of 40, who should then receive their alloSCT as early consolidation therapy following induction chemotherapy. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Fistula Risk Score-Adjusted Comparison of Postoperative Pancreatic Fistula between Laparoscopic versus Open Pancreatoduodenectomy

HPB ◽  
2019 ◽  
Vol 21 ◽  
pp. S265
Author(s):  
Boram Lee ◽  
Yoo-Seok Yoon ◽  
Chang Moo Kang ◽  
Ho Kyoung Hwang ◽  
Ho-Seong Han ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Risk Score ◽  
Postoperative Pancreatic Fistula ◽  
Fistula Risk Score

scholarly journals Predicting postoperative pancreatic fistula in pancreatic head resections: which score fits all?

2021 ◽  
Author(s):  
Mariam Adamu ◽  
Verena Plodeck ◽  
Claudia Adam ◽  
Anne Roehnert ◽  
Thilo Welsch ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Risk Score ◽  
Pancreatic Head ◽  
Major Complication ◽  
Risk Groups ◽  
Postoperative Pancreatic Fistula ◽  
Prognostic Scores ◽  
Risk Scores ◽  
Reactive Protein ◽  
Prognostic Stratification

Abstract Purpose Postoperative pancreatic fistula (POPF) is a major complication of pancreatic surgery and can be fatal. Better stratification of patients into risk groups may help to select those who might benefit from strategies to prevent complications. The aim of this study was to validate ten prognostic scores in patients who underwent pancreatic head surgery. Methods A total of 364 patients were included in this study between September 2012 and August 2017. Ten risk scores were applied to this cohort. Univariate and multivariate analyses were performed considering all risk factors in the scores. Furthermore, the stratification of patients into risk categories was statistically tested. Results Nine of the scores (Ansorge et al., Braga et al., Callery et al., Graham et al., Kantor et al., Mungroop et al., Roberts et al., Yamamoto et al. and Wellner et al.) showed strong prognostic stratification for developing POPF (p < 0.001). There was no significant prognostic value for the Fujiwara et al. risk score. Histology, pancreatic duct diameter, intraabdominal fat thickness in computed tomography findings, body mass index, and C-reactive protein were independent prognostic factors on multivariate analysis. Conclusion Most risk scores tend to stratify patients correctly according to risk for POPF. Nevertheless, except for the fistula risk score (Callery et al.) and its alternative version (Mungroop et al.), many of the published risk scores are obscure even for the dedicated pancreatic surgeon in terms of their clinical practicability. There is a need for future studies to provide strategies for preventing POPF and managing patients with high-risk stigmata.

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