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Clinical significance of postoperative acute pancreatitis after pancreatoduodenectomy and distal pancreatectomy

Published:September 03, 2020DOI:https://doi.org/10.1016/j.surg.2020.06.040

      Abstract

      Background

      The definition of postoperative acute pancreatitis as a specific complication of pancreatic surgery was proposed in 2016. Its presence and relevance have not been established, especially after a distal pancreatectomy.

      Methods

      Medical records of 319 patients who underwent pancreatoduodenectomy or distal pancreatectomy were analyzed. Postoperative acute pancreatitis was defined as an increase in serum amylase activity greater than the upper normal limit on postoperative day 1, according to Connor’s definition of postoperative acute pancreatitis.

      Results

      Postoperative acute pancreatitis occurred in 63.4% of 153 of the patients undergoing pancreatoduodenectomy and 65.7% of the 166 undergoing distal pancreatectomies. Patients who developed postoperative acute pancreatitis after pancreatoduodenectomy experienced an increase in the rate of morbidity (22.7% vs 7.1%; P = .0137), including postoperative pancreatic fistula (18.6% vs 1.8%; P = .024), resulting in greater postoperative stays (21 days vs 17 days; P = .0008). Postoperative acute pancreatitis in association with an increased serum C-reactive protein ≥18.0 mg/dL (which we defined as a clinically relevant postoperative acute pancreatitis) more strongly indicated the occurrence of severe complications (P = .0032) and was an independent predictor of postoperative pancreatic fistula after pancreatoduodenectomy (odds ratio, 3.03; P = .0448). Patients who developed postoperative acute pancreatitis after distal pancreatectomy experienced similar postoperative courses regarding morbidity and the duration of postoperative stay.

      Conclusion

      The clinical relevance of postoperative acute pancreatitis differs after a pancreatoduodenectomy versus a distal pancreatectomy. The development of effective strategies for preventing postoperative acute pancreatitis might improve surgical outcomes after pancreatoduodenectomy.
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      Linked Article

      • Acute pancreatitis after pancreatectomy: Inside the dilemma pancreatitis-pancreatic fistula
        SurgeryVol. 169Issue 4
        • Preview
          The interesting paper by Ikenaga et al about acute pancreatitis after pancreatic resections merits some patho-physiological observations.1 Besides pathogenic elements in common with other abdominal operations, we identify as a specific factor the acute postoperative stasis of pancreatic juice, leading to a subsequent acute pancreatitis. In case of distal pancreatectomy, and independently from the techniques of pancreatic stump sealing, this factor induces an acute pancreatitis in the area surrounding the section rim, possibly evolving into a diffuse pancreatitis or in a Wirsung duct fistula.
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