scholarly journals Total Amylase Value in Drains After Gastrectomy for Predicting Postoperative Pancreatic Fistula

2020 ◽  
Author(s):  
Toshitaka Sugawara ◽  
Hisashi Shinohara ◽  
Shusuke Haruta ◽  
Junichi Shindo ◽  
Masaki Ueno ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Concentration Ratio ◽  
Univariate Analysis ◽  
Area Under The Curve ◽  
Predictive Performance ◽  
Roc Curves ◽  
Postoperative Pancreatic Fistula ◽  
Amylase Level ◽  
Anastomotic Site ◽  
Drainage Fluid

Objective: Postoperative pancreatic fistula (POPF) is defined using the ratio of the bilirubin concentration in abdominal drainage fluid to the upper normal range of serum amylase level. However, we hypothesized that the total amylase value in discharge (AVD) on POD 3 may be more sensitive for predicting grade II or higher severe POPF sPOPF, and compared the predictive power of the conventional definition of POPF and AVD for sPOPF. Methods: One hundred and fifty-one patients who underwent gastrectomy between October 2011 and February 2013 were analyzed. A drainage tube was placed in all the cases through the stump of the right gastroepiploic vein and the front of the pancreas to the back of the anastomotic site. The drainage volume and amylase concentration in the discharge were examined on POD 1, 3, and 5. AVD was calculated by multiplying the volume by the amylase concentration. Results: Eight patients (5.3%) developed sPOPF. In univariate analysis, both AVD and the amylase concentration ratio was significantly correlated with sPOPF (P = 0.002 and 0.007, respectively). AVD on POD 3 showed the best predictive performance compared with the amylase concentration ratio on POD 3 (area under the curve 0.876 vs. 0.844). Based on the cutoff values calculated from the ROC curves, AVD was more specific than amylase concentration ratio in predicting sPOPF (specificity: 97.6% vs. 86.0%; PPV: 62.5% vs. 23.1%). Conclusion: AVD on POD 3 is a more specific parameter than conventional amylase concentration ratio in predicting sPOPF.

scholarly journals Analysis of pancreatic fistula risk in patients with laparoscopic pancreatoduodenectomy: what matters

2020 ◽  
Vol 48 (7) ◽  
pp. 030006052094342
Author(s):  
Kate Nong ◽  
Yue Zhang ◽  
Shengyong Liu ◽  
Yue Yang ◽  
Donglin Sun ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pancreatic Fistula ◽  
Bilirubin Level ◽  
Multiple Logistic Regression Analysis ◽  
Univariate Analysis ◽  
Amylase Level ◽  
Drainage Fluid ◽  
Soft Pancreas ◽  
Laparoscopic Pancreatoduodenectomy ◽  
Potential Risk Factors

Objective To analyse potential risk factors for postoperative pancreatic fistula (POPF). Methods A retrospective study on risk factors for POPF was conducted in patients undergoing laparoscopic pancreatoduodenectomy. Basic characteristics, and preoperative, intraoperative and postoperative patient data were collected and analysed. Results A total of 268 patients were enrolled in this study, including 54 patients with POPF following surgery (POPF incidence, 20.15%). Univariate analysis indicated that patient’s age, body mass index (BMI), preoperative bilirubin level, pancreas texture, and drainage fluid amylase level on day 1 following surgery were associated with POPF. Multiple logistic regression analysis indicated that preoperative bilirubin level ≥170 µmol/l, soft pancreas texture, BMI ≥25, and age ≥65 years were independent risk factors associated with POPF. Conclusions For patients with preoperative bilirubin level ≥170 µmol/l, soft pancreas texture, BMI ≥25 and age ≥65 years, clinically relevant measures should be taken as early as possible for the prophylaxis of POPF.

scholarly journals Postoperative day 3 drain amylase versus fistula risk score: predicting clinically relevant postoperative pancreatic fistula following pancreatico-duodenectomy

2019 ◽  
Vol 7 (1) ◽  
pp. 227
Author(s):  
Nagesh Nayakarahally Swamy Gowda ◽  
Sathish Obalanarasimhaiah ◽  
Balakrishna N. Setty ◽  
Jyotirmay Jena ◽  
Mannem Manoj Kumar
Keyword(s):  
Pancreatic Fistula ◽  
Risk Score ◽  
Enhanced Recovery ◽  
Area Under The Curve ◽  
Roc Curves ◽  
Postoperative Management ◽  
Postoperative Pancreatic Fistula ◽  
Perioperative Morbidity ◽  
Drain Amylase ◽  
Fistula Risk Score

Background: Clinically relevant postoperative pancreatic fistula (CR-POPF) remains the most common cause of perioperative morbidity following pancreatico-duodenectomy (PD). Early and accurate prediction of CR-POPF can be helpful in postoperative drain management as well as stratifying patients for enhanced recovery protocol after surgery. Both fistula risk score (FRS) and postoperative drain amylase levels have been analyzed in past. However, currently there is no clear consensus regarding the ideal predictor. Present study sought to assess the utility of postoperative day 3 drain amylase (POD-3DA) level as a predictor of CR-POPF in comparison with FRS.Methods: A retrospective analysis was done on 57 patients who underwent PD at our institute between 2014 to 2018. POPF was defined and graded in accordance with ISGPF definition. Receiver operating characteristic (ROC) analysis predicted a threshold of POD3DA >486 IU/l associated with CR-POPF. Sensitivity, specificity and odds ratios with 95%CI calculated and ROC curves were plotted for POD3DA of ≥500 IU/l and FRS (negligible/low vs. moderate/ high) as predictors of CR-POPF.Results: Incidence of POPF and CR-POPF was 63% and 32% respectively. Sensitivity and specificity of POD3DA ≥500 and moderate/high FRS for predicting CR-POPF were 83%, 79% & 78%, 51% respectively. Difference between ROC area under the curve (AUC) for POD3DA ≥500 IU/l (0.868) and FRS (0.692) was significant (p=0.028). Combining FRS and POD3DA ≥500 IU/l improved specificity (87%) at the cost of sensitivity (67%). The negative predictive value of POD3DA <500 IU/l and negligible/low FRS were 91.2% and 83.3% respectively.Conclusions: POD3DA level greater than 5 times of upper normal range is more precise at predicting CR-POPF, hence clinically more reliable for drain and postoperative management. 

scholarly journals Dynamic prediction for clinically relevant pancreatic fistula: a novel prediction model for laparoscopic pancreaticoduodenectomy

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Runwen Liu ◽  
Yunqiang Cai ◽  
He Cai ◽  
Yajia Lan ◽  
Lingwei Meng ◽  
...  
Keyword(s):  
Prediction Model ◽  
Pancreatic Fistula ◽  
Postoperative Pancreatic Fistula ◽  
Laparoscopic Pancreaticoduodenectomy ◽  
C Reactive Protein ◽  
Dynamic Prediction ◽  
Albumin Ratio ◽  
Drainage Fluid ◽  
Reactive Protein ◽  
Baseline Factors

Abstract Background With the recent emerge of dynamic prediction model on the use of diabetes, cardiovascular diseases and renal failure, and its advantage of providing timely predicted results according to the fluctuation of the condition of the patients, we aim to develop a dynamic prediction model with its corresponding risk assessment chart for clinically relevant postoperative pancreatic fistula after laparoscopic pancreaticoduodenectomy by combining baseline factors and postoperative time-relevant drainage fluid amylase level and C-reactive protein-to-albumin ratio. Methods We collected data of 251 patients undergoing LPD at West China Hospital of Sichuan University from January 2016 to April 2019. We extracted preoperative and intraoperative baseline factors and time-window of postoperative drainage fluid amylase and C-reactive protein-to-albumin ratio relevant to clinically relevant pancreatic fistula by performing univariate and multivariate analyses, developing a time-relevant logistic model with the evaluation of its discrimination ability. We also established a risk assessment chart in each time-point. Results The proportion of the patients who developed clinically relevant postoperative pancreatic fistula after laparoscopic pancreaticoduodenectomy was 7.6% (19/251); preoperative albumin and creatine levels, as well as drainage fluid amylase and C-reactive protein-to-albumin ratio on postoperative days 2, 3, and 5, were the independent risk factors for clinically relevant postoperative pancreatic fistula. The cut-off points of the prediction value of each time-relevant logistic model were 14.0% (sensitivity: 81.9%, specificity: 86.5%), 8.3% (sensitivity: 85.7%, specificity: 79.1%), and 7.4% (sensitivity: 76.9%, specificity: 85.9%) on postoperative days 2, 3, and 5, respectively, the area under the receiver operating characteristic curve was 0.866 (95% CI 0.737–0.996), 0.896 (95% CI 0.814–0.978), and 0.888 (95% CI 0.806–0.971), respectively. Conclusions The dynamic prediction model for clinically relevant postoperative pancreatic fistula has a good to very good discriminative ability and predictive accuracy. Patients whose predictive values were above 14.0%, 8.3%, and 7.5% on postoperative days 2, 3, and 5 would be very likely to develop clinically relevant postoperative pancreatic fistula after laparoscopic pancreaticoduodenectomy.

scholarly journals Magnetic resonance cisternography imaging findings related to the leakage of Gadolinium into the subarachnoid space

2021 ◽  
Author(s):  
Rei Nakamichi ◽  
Toshiaki Taoka ◽  
Hisashi Kawai ◽  
Tadao Yoshida ◽  
Michihiko Sone ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Subarachnoid Space ◽  
Area Under The Curve ◽  
Rank Correlation ◽  
Predictive Performance ◽  
Roc Curves ◽  
Imaging Findings ◽  
Spearman’S Rank Correlation ◽  
Sagittal Sinus ◽  
Magnetic Resonance Cisternography

Abstract Purpose To identify magnetic resonance cisternography (MRC) imaging findings related to Gadolinium-based contrast agent (GBCA) leakage into the subarachnoid space. Materials and methods The number of voxels of GBCA leakage (V-leak) on 3D-real inversion recovery images was measured in 56 patients scanned 4 h post-intravenous GBCA injection. Bridging veins (BVs) were identified on MRC. The numbers of BVs with surrounding cystic structures (BV-cyst), with arachnoid granulations protruding into the superior sagittal sinus (BV-AG-SSS) and the skull (BV-AG-skull), and including any of these factors (BV-incl) were recorded. Correlations between these variables and V-leak were examined based on the Spearman’s rank correlation coefficient. Receiver-operating characteristic (ROC) curves were generated to investigate the predictive performance of GBCA leakage. Results V-leak and the number of BV-incl were strongly correlated (r = 0.609, p < 0.0001). The numbers of BV-cyst and BV-AG-skull had weaker correlations with V-leak (r = 0.364, p = 0.006; r = 0.311, p = 0.020, respectively). The number of BV-AG-SSS was not correlated with V-leak. The ROC curve for contrast leakage exceeding 1000 voxels and the number of BV-incl had moderate accuracy, with an area under the curve of 0.871. Conclusion The number of BV-incl may be a predictor of GBCA leakage and a biomarker for waste drainage function without using GBCA.

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

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.

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

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.

scholarly journals Anastomosis technique for pancreatojejunostomy and early removal of drainage tubes may reduce postoperative pancreatic fistula

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Hiromichi Kawaida ◽  
Hiroshi Kono ◽  
Hidetake Amemiya ◽  
Naohiro Hosomura ◽  
Mitsuaki Watanabe ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Pancreatic Fistula ◽  
Postoperative Pancreatic Fistula ◽  
Conventional Group ◽  
Short Term ◽  
Drainage Fluid ◽  
The Third ◽  
Modified Method ◽  
Early Removal ◽  
Soft Pancreas

Abstract Background Postoperative pancreatic fistula (POPF) is one of the most serious complications after pancreaticoduodenectomy (PD). Various factors have been reported as POPF risks, but the most serious of these is soft pancreas. To reduce POPF occurrences, many changes to the PD process have been proposed. This study evaluates short-term results of anastomosis technique for PD. Methods In total, 123 patients with soft pancreases who had undergone PD at Yamanashi University between January 2012 and August 2020 were retrospectively analyzed. We divided these patients into two groups depending on the time PD was performed: a conventional group (n = 67) and a modified group (n = 56). Results The rate of clinically relevant POPF was significantly lower in the modified group than that in the conventional group (5.4% vs 22.4%, p value < 0.001), with there being only one case of POPF in the modified group. There were no cases of POPF-related hemorrhaging in the modified group. On the third day after the operation, the amylase levels in the drainage fluid for the modified group became less than half (1696 vs 650 U/L). Multivariate analysis showed that the modified method was the independent predictors to prevent clinical POPF (p value = 0.002). Conclusions Our novel anastomosis technique for pancreatojejunostomy reduced POPF in PD, especially in cases where the patient had a soft pancreas.

scholarly journals A predictive model to estimate survival of hospitalized COVID-19 patients from admission data

2020 ◽  
Author(s):  
Todd J. Levy ◽  
Safiya Richardson ◽  
Kevin Coppa ◽  
Douglas P. Barnaby ◽  
Thomas McGinn ◽  
...  
Keyword(s):  
Survival Probability ◽  
Predictive Accuracy ◽  
Area Under The Curve ◽  
Predictive Performance ◽  
Roc Curves ◽  
Severity Index ◽  
Primary Objective ◽  
Lasso Regression ◽  
Distribution Width ◽  
Serum Blood Urea Nitrogen

AbstractObjectiveOur primary objective was to use initial data available to clinicians to characterize and predict survival for hospitalized coronavirus disease 2019 (COVID-19) patients. While clinical characteristics and mortality risk factors of COVID-19 patients have been reported, a practical survival calculator based on data from a diverse group of U.S. patients has not yet been introduced. Such a tool would provide timely and valuable guidance in decision-making during this global pandemic.DesignWe extracted demographic, laboratory, clinical, and treatment data from electronic health records and used it to build and test the predictive accuracy of a survival probability calculator referred to as “the Northwell COVID-19 Survival (‘NOCOS’) calculator.”Setting13 acute care facilities at Northwell Health served as the setting for this study.Participants5,233 hospitalized COVID-19–positive patients served as the participants for this study.Main outcome measuresThe NOCOS calculator was constructed using multivariate regression with L1 regularization (LASSO) to predict survival during hospitalization. Model predictive performance was measured using Receiver Operating Characteristic (ROC) curves and the Area Under the Curve (AUC) of the calculators.ResultsPatient age, serum blood urea nitrogen, Emergency Severity Index, red cell distribution width, absolute neutrophil count, serum bicarbonate, and glucose were identified as the optimal predictors of survival by multivariate LASSO regression. The predictive performance of the NOCOS calculator had an AUC of 0.832, reaching 0.91 when updated for each patient daily, with stability assessed and maintained for 14 consecutive days. This outperformed other established models, including the Sequential Organ Failure Assessment (SOFA) score (0.732).ConclusionsWe present a practical estimate of survival probability that outperforms other general risk models. The seven early predictors of in-hospital survival can help clinicians identify patients with increased probabilities of survival and provide critical decision support as COVID-19 spreads across the U.S.Trial registrationN/A

scholarly journals Prone position increases the risk of pancreatic fistula after laparoscopic radical gastrectomy combined with heated intraperitoneal chemotherapy: a case report

2020 ◽  
Author(s):  
Xing An ◽  
Xiangwen Weng ◽  
Li Li ◽  
Qingsong Huang ◽  
Kunlan Long ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Prone Position ◽  
Intraperitoneal Chemotherapy ◽  
Abdominal Cavity ◽  
Postoperative Pancreatic Fistula ◽  
General Surgeon ◽  
Abdominal Pressure ◽  
Radical Gastrectomy ◽  
Drainage Fluid ◽  
Heated Intraperitoneal Chemotherapy

Abstract Background: There has not been reported that prone position increases the risk of postoperative pancreatic fistula. We present a case of prone position leading to hyperthermia and pancreatic fistula in a patient with acute respiratory distress syndrome(ARDS) after laparoscopic radical gastrectomy(LRG) combined with heated intraperitoneal chemotherapy(HIPEC).Case presentation: A 68-year-old male developed moderate ARDS after LRG combined with HIPEC. Since low tidal volume and high positive end expiratory pressure(PEEP) ventilation could not improve oxygenation, prone ventilation was selected to improve heterogeneous lung injury. However, chills and fever appeared after the position change. Abdominal computed tomography (CT) showed that the mesenteric fat space in the middle abdomen was fuzzy, local exudation was increased, and the boundary of pancreas was not clear. The increase of amylase in peritoneal drainage fluid was 10 times higher than that in serum amylase. After communicating with the general surgeon, we learned that during the operation, the surgeon had opened the pancreatic capsule to clean the local lymph nodes. It was considered that prone position lead to the sharp increase of abdominal pressure, especially the change of peripancreatic pressure. The visceral organs of the abdominal cavity squeezed each other, the pancreatic tissue was compressed, the pancreatic juice extravasation occurred, and even aggravated the pancreatic fistula. In the follow-up treatment process, the patient were given continuous abdominal drainage and avoided prone position as far as possible. Since then, the patient's temperature tended to be stable. On the 10th day after the operation, the patient successfully withdrew from the ventilator and transferred to the general ward for further specialized treatment.Conclusion: Our case adds further concerns in ARDS patients after LRG combined with HIPEC, including the monitoring of postoperative pancreatic fistula and how to perform prone ventilation more safely.

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