To Study the Biochemical Markers for the Prediction of Fistula Formation after Pancreatic Resection Surgery in the Post Operative Period

Background: To study and assess the potential laboratory biomarkers for foreseeing postoperative pancreatic fistula (POPF) after pancreatic resection medical procedures. Subjects and Methods: 64 patients were studied from Jan 2008 to Dec 2018. All patients undergoing Pancreatic resection surgeries like Pancreaticoduodenectomy (PD), distal Pancreatectomy (DP) for tumors of the periampullary region, Pancreatic body or chronic pancreatitis Clinical data of the patients, surgical approach, pancreatic parenchymal tissue consistency, histopathology of the specimen, white blood cell count and blood amylase levels tube Drain fluid amylase were recorded and analyzed. Correlations between these parameters and postoperative pancreatic fistula (POPF) were assessed. Results : 22 out of the 64 (34.37%) patients developed POPF. The fistula was graded according to the ISPG classification. It was Grade An of every 10 (45.45%) patients, grade B in 8 (36.36%), and grade C in 4 (18.18%),.On univariate and multivariate strategic relapse investigations, higher amylase levels in the stomach waste liquid on a postoperative day (POD)1 and higher serum amylase levels on POD4 indicated a critical relationship with fistula arrangement in the post-operation period (POPF) (P < 0.05). On ROC (recipient working trademark bend) examination, amylase cut-off degree of 2270.67 U/L in the stomach waste liquid was related with a 76.6% affectability and 82% particularity [area under the bend (AUC): 0.844; P = 0.009]. A cut-off serum amylase level of 53.2 U/L was related with a 74.6% affectability and 72.9% explicitness (AUC: 0.784; P = 0.05). Conclusion: Post-operative channel liquid amylase levels on day 1 and serum amylase level on day 4 speak to interesting biomarkers related to POPF improvement after the pancreatic medical procedure.

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Evaluation of Drain Amylase Level after Pancreaticoduodenectomy with Special Reference to Delayed Pancreatic Fistula

The American Surgeon ◽

10.1177/000313481808400325 ◽

2018 ◽

Vol 84 (3) ◽

pp. 403-409

Author(s):

Takashi Maeda ◽

Hiroto Kayashima ◽

Daisuke Imai ◽

Kazuki Takeishi ◽

Noboru Harada ◽

...

Keyword(s):

Pancreatic Fistula ◽

Clinical Characteristics ◽

Serum Amylase ◽

Postoperative Pancreatic Fistula ◽

Amylase Level ◽

Pancreatic Ducts ◽

Fatal Complication ◽

Drain Removal ◽

Soft Pancreas ◽

Drain Amylase

Postoperative pancreatic fistula (PF) is a relatively frequent and occasionally fatal complication of pancreatoduodenectomy (PD). Several risk factors for PF have been reported, including high drain amylase level (D-AMY). Among the 140 consecutive patients who underwent PD, we analyzed 110 cases with D-AMY measurements over time after PD. According to the D-AMY change, we divided patients into five patterns and defined delayed PF cases. We analyzed clinical characteristics, including serum amylase and D-AMY, and examined the correlation between the period of drain insertion and PF grade. In 15 delayed PF cases, 12 cases were grade B or C, pancreatic cancer was less frequent, pancreatic ducts were smaller, and soft pancreas texture was more commonly observed. The D-AMYon postoperative day (POD) 1 was higher in cases of delayed PF compared with non-PF cases ( P < 0.0001). In 28 cases with drain removal before POD 7, grade B or C PF was not observed afterward. The average D-AMYon POD 1 in cases with drain removal before POD 1 was significantly lower than in delayed PF cases. Although further studies are required to determine the most appropriate timing of drain removal, it is thought that intra-abdominal drains should be removed within seven days of PD in cases without signs of PF. On the other hand, delayed PF should be considered in cases of soft pancreas texture and/or high D-AMY on POD 1, even if D-AMY levels are low on POD 3 or decreasing on POD 5.

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Combined prognostic nutritional index ratio and serum amylase level during the early postoperative period predicts pancreatic fistula following pancreaticoduodenectomy

BMC Surgery ◽

10.1186/s12893-020-00838-0 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Teruhisa Sakamoto ◽

Takuki Yagyu ◽

Ei Uchinaka ◽

Masaki Morimoto ◽

Takehiko Hanaki ◽

...

Keyword(s):

Pancreatic Fistula ◽

Postoperative Period ◽

Serum Amylase ◽

Prognostic Nutritional Index ◽

Early Postoperative Period ◽

Amylase Level ◽

Serum Amylase Level ◽

Nutritional Index ◽

Index Ratio

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The Combination of Pancreas Texture and Postoperative Serum Amylase in Predicting Pancreatic Fistula Risk

The American Surgeon ◽

10.1177/000313481808400637 ◽

2018 ◽

Vol 84 (6) ◽

pp. 889-896 ◽

Cited By ~ 4

Author(s):

Crystal B. Chen ◽

Neal S. McCall ◽

Michael J. Pucci ◽

Benjamin Leiby ◽

Nooreen Dabbish ◽

...

Keyword(s):

Pancreatic Fistula ◽

Serum Amylase ◽

Characteristic Curve ◽

Multivariable Analysis ◽

Threshold Value ◽

Amylase Level ◽

Serum Amylase Level ◽

Soft Pancreas ◽

Postoperative Serum ◽

The Relationship

Postoperative pancreatic fistula (PF) remains one of the most significant complications after pancreaticoduodenectomy (PD). Recently, studies have suggested that post-PD serum hyper-amylasemia (HA) may be a risk factor. In this study, we evaluate the relationship of pancreas texture and post-operative serum amylase levels in determining PF risk. This retrospective cohort study evaluated all patients who underwent PD at Thomas Jefferson University from 2009 to 2014. The highest postoperative serum amylase level from postoperative day (POD) 0 to POD 5 was obtained. Chi-square analyses and odds ratio (OR) evaluated the relationship between pancreas texture, serum amylase level, and the development of PF. Data from 524 consecutive patients were analyzed. Serum amylase threshold value of 165 IU/L yielded greatest accuracy from the receiver operating characteristic curve analysis (Sensitivity, 0.70; specificity, 0.72). Grade B or C PF were more common among HA patients (20 vs 3%; P < 0.001). HA was associated with increased rates of PD-associated complications. On multivariable analysis, early postoperative serum HA was more predictive of PF risk (OR, 4.87; P < 0.001) than either pancreatic duct size ≤3 mm (OR, 2.97; P = 0.01) or pancreas texture (OR,1.87; P = 0.05). Conclusion: The presence of HA on POD 0 or POD 1 is more predictive than soft pancreas texture or small pancreas duct size alone.

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Successful postoperative pancreatic fistula treatment with the use of somatostatin infusion after duodenal gastrointestinal stromal tumor resection

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh180413053c ◽

2019 ◽

Vol 147 (7-8) ◽

pp. 484-487

Author(s):

Mariusz Chabowski ◽

Wiktor Pawlowski ◽

Michał Lesniak ◽

Agnieszka Ziomek ◽

Maciej Malinowski ◽

...

Keyword(s):

Parenteral Nutrition ◽

Gastrointestinal Stromal Tumor ◽

Pancreatic Fistula ◽

Pancreatic Secretion ◽

Postoperative Pancreatic Fistula ◽

Stromal Tumor ◽

Fistula Formation ◽

Clinical State ◽

Amylase Level ◽

Clinical Awareness

Introduction. According to the International Study Group on Pancreatic Fistula, a postoperative pancreatic fistula is defined as every case of fluid leak on the third (or later) postoperative day, in which the level of amylase in the collected fluid is at least three times higher than the serum amylase level. Depending on the stage and the designated management, pancreatic fistulas are divided into the following three categories: A (mild), B, and C (severe). Regardless of favorable conditions, exocrine pancreatic secretion is the key factor in fistula formation. The decrease in pancreatic secretion caused by somatostatin and its analogues combined with parenteral nutrition is a well-established treatment method in pancreatic fistula management. Case outline. The case of a 69-year-old patient who had undergone a resection of a duodenal gastrointestinal stromal tumor located directly above the major duodenal papilla is presented. Excessive drainage of amylase-rich fluid was observed in the postoperative period. Treatment comprised continuous infusion of somatostatin and parenteral nutrition. Fistula closure was accomplished on postoperative day 14, confirmed by a radical decrease in the volume of drainage and low amylase levels in the collected fluid. The patient remained in a good clinical state and was discharged from hospital on postoperative day 20. Conclusion. This is an example of the early diagnosis of a postoperative pancreatic fistula, treated conservatively with the use of somatostatin. Post-surgery clinical awareness of the importance of direct contact between the stromal tumor and pancreatic tissues, in connection with routine amylase level assessment, led to a quick diagnosis of pancreatic fistula and the therapy led to an uneventful outcome.

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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.

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Comparison of prognostic impact of anatomic location of the pancreas on postoperative pancreatic fistula in laparoscopic and open gastrectomy

BMC Gastroenterology ◽

10.1186/s12876-020-01476-9 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Jun Kinoshita ◽

Takahisa Yamaguchi ◽

Hiroto Saito ◽

Hideki Moriyama ◽

Mari Shimada ◽

...

Keyword(s):

Gastric Cancer ◽

Pancreatic Fistula ◽

Left Gastric Artery ◽

Postoperative Pancreatic Fistula ◽

Open Gastrectomy ◽

Amylase Level ◽

Prognostic Impact ◽

Anatomic Location ◽

Significant Difference ◽

Preoperative Ct

Abstract Background Postoperative pancreatic fistula (POPF) is a serious complication after gastric cancer surgery. The current study aimed to investigate the significance of the anatomic location of the pancreas as a predictor for POPF in both laparoscopic gastrectomy (LG) and open gastrectomy (OG). Methods In total, 233 patients with gastric cancer were assessed retrospectively. We measured the maximum vertical (P-L height; PLH) and horizontal length (P-L depth; PLD) between the upper border of pancreas and the root of left gastric artery on a preoperative CT in the sagittal direction. The maximum length of the vertical line between the surface of the pancreas and the aorta (P-A length), previously reported as prognostic factor of POPF, was also measured. We investigated the correlations between these parameters and the incidence of POPF in LG and OG groups. Results Among the patients in this study, 118 underwent OG and 115 underwent LG. In LG, the median PLH and P-A length in patients with POPF were significantly longer compared with those without POPF (p = 0.026, 0.034, respectively), but not in OG. There was no significant difference in the median PLD between the patients with or without POPF in both LG and OG. The multivariate analysis demonstrated that PLH (odds ratio [OR] 4.19, 95% confidence interval [CI] 1.57–11.3, P = 0.004) and P-A length (OR 4.06, 95%CI 1.05–15.7, P = 0.042] were independent factors for predicting POPF in LG. However, intraoperative blood loss (OR 2.55, 95%CI 1.05–6.18, P = 0.038) was extracted as an independent factor in OG. The median amylase level in the drained fluid (D-Amy) were significantly higher in patients with high PLH(≥12.4 mm) or high P-A length (≥45 mm) compared with those with low PLH or low P-A length in LG. However, there were no differences in the D-Amy levels by PLH or P-A length in OG patients. Conclusions The anatomic location of the pancreas is a specific and independent predictor of POPF in LG but not in OG. PLH is a simple parameter that can evaluate the anatomic position of the pancreas, and it may be useful for preventing POPF after LG.

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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

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Comparison of prognostic impact of anatomic location of the pancreas on postoperative pancreatic fistula in laparoscopic and open gastrectomy

10.21203/rs.3.rs-53308/v3 ◽

2020 ◽

Author(s):

Jun Kinoshita ◽

Takahisa Yamaguchi ◽

Hiroto Saito ◽

Hideki Moriyama ◽

Mari Shimada ◽

...

Keyword(s):

Gastric Cancer ◽

Pancreatic Fistula ◽

Left Gastric Artery ◽

Postoperative Pancreatic Fistula ◽

Open Gastrectomy ◽

Amylase Level ◽

Prognostic Impact ◽

Anatomic Location ◽

Significant Difference ◽

Preoperative Ct

Abstract Background: Postoperative pancreatic fistula (POPF) is a serious complication after gastric cancer surgery. The current study aimed to investigate the significance of the anatomic location of the pancreas as a predictor for POPF in both laparoscopic gastrectomy (LG) and open gastrectomy (OG). Methods: In total, 233 patients with gastric cancer were assessed retrospectively. We measured the maximum vertical (P-L height; PLH) and horizontal length (P-L depth; PLD) between the upper border of pancreas and the root of left gastric artery on a preoperative CT in the sagittal direction. The maximum length of the vertical line between the surface of the pancreas and the aorta (P-A length), previously reported as prognostic factor of POPF, was also measured. We investigated the correlations between these parameters and the incidence of POPF in LG and OG groups. Results: Among the patients in this study, 118 underwent OG and 115 underwent LG. In LG, the median PLH and P-A length in patients with POPF were significantly longer compared with those without POPF (p=0.026, 0.034, respectively), but not in OG. There was no significant difference in the median PLD between the patients with or without POPF in both LG and OG. The multivariate analysis demonstrated that PLH (odds ratio [OR] 4.19, 95% confidence interval [CI] 1.57–11.3, P=0.004) and P-A length (OR 4.06, 95%CI 1.05–15.7, P=0.042] were independent factors for predicting POPF in LG. However, intraoperative blood loss (OR 2.55, 95%CI 1.05–6.18, P=0.038) was extracted as an independent factor in OG. The median amylase level in the drained fluid (D-Amy) were significantly higher in patients with high PLH(≥12.4 mm) or high P-A length (≥45 mm) compared with those with low PLH or low P-A length in LG. However, there were no differences in the D-Amy levels by PLH or P-A length in OG patients. Conclusions: The anatomic location of the pancreas is a specific and independent predictor of POPF in LG but not in OG. PLH is a simple parameter that can evaluate the anatomic position of the pancreas, and it may be useful for preventing POPF after LG.

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