Clinical significance of postoperative acute pancreatitis after pancreatoduodenectomy and distal pancreatectomy

Published:September 03, 2020DOI:



      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.


      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.


      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.


      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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        • Pulvirenti A.
        • Marchegiani G.
        • Pea A.
        • et al.
        Clinical implications of the 2016 International Study Group on Pancreatic Surgery definition and grading of postoperative pancreatic fistula on 775 consecutive pancreatic resections.
        Ann Surg. 2018; 268: 1069-1075
        • Bassi C.
        • Dervenis C.
        • Butturini G.
        • et al.
        • and the International Study Group on Pancreatic Fistula Definition
        Postoperative pancreatic fistula: An international study group (ISGPF) definition.
        Surgery. 2005; 138: 8-13
        • Bassi C.
        • Marchegiani G.
        • Dervenis C.
        • et al.
        • and the International Study Group on Pancreatic Surgery (ISGPS)
        The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after.
        Surgery. 2017; 161: 584-591
        • Farley D.R.
        • Schwall G.
        • Trede M.
        Completion pancreatectomy for surgical complications after pancreaticoduodenectomy.
        Br J Surg. 1996; 83: 176-179
        • Räty S.
        • Sand J.
        • Lantto E.
        • Nordback I.
        Postoperative acute pancreatitis as a major determinant of postoperative delayed gastric emptying after pancreaticoduodenectomy.
        J Gastrointest Surg. 2006; 10: 1131-1139
        • Räty S.
        • Sand J.
        • Nordback I.
        Detection of postoperative pancreatitis after pancreatic surgery by urine trypsinogen strip test.
        Br J Surg. 2007; 94: 64-69
        • Cuthbertson C.M.
        • Christophi C.
        Disturbances of the microcirculation in acute pancreatitis.
        Br J Surg. 2006; 93: 518-530
        • Connor S.
        Defining post-operative pancreatitis as a new pancreatic specific complication following pancreatic resection.
        HPB (Oxford). 2016; 18: 642-651
        • Bannone E.
        • Andrianello S.
        • Marchegiani G.
        • et al.
        Postoperative acute pancreatitis following pancreaticoduodenectomy: A determinant of fistula potentially driven by the intraoperative fluid management.
        Ann Surg. 2018; 268: 815-822
        • Banks P.A.
        • Bollen T.L.
        • Dervenis C.
        • et al.
        • and the Acute Pancreatitis Classification Working Group
        Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus.
        Gut. 2013; 62: 102-111
        • Kühlbrey C.M.
        • Samiei N.
        • Sick O.
        • Makowiec F.
        • Hopt U.T.
        • Wittel U.A.
        Pancreatitis after pancreatoduodenectomy predicts clinically relevant postoperative pancreatic fistula.
        J Gastrointest Surg. 2017; 21: 330-338
        • Partelli S.
        • Tamburrino D.
        • Andreasi V.
        • Mazzocato S.
        • Crippa S.
        • Perretti E.
        • et al.
        Implications of increased serum amylase after pancreaticoduodenectomy: toward a better definition of clinically relevant postoperative acute pancreatitis.
        HBP (Oxford). 2020; (S1365-182X(20)30092-7)
        • Tanaka M.
        • Tomikawa M.
        • Nakamura M.
        • et al.
        Gastroenterological surgery: Pancreas.
        Asian J Endosc Surg. 2015; 8: 239-242
        • Meniconi R.L.
        • Caronna R.
        • Borreca D.
        • Schiratti M.
        • Chirletti P.
        Pancreato-jejunostomy versus hand-sewn closure of the pancreatic stump to prevent pancreatic fistula after distal pancreatectomy: a retrospective analysis.
        BMC Surg. 2013; 13: 23
        • Wente M.N.
        • Bassi C.
        • Dervenis C.
        • et al.
        Delayed gastric emptying (DGE) after pancreatic surgery: A suggested definition by the International Study Group of Pancreatic Surgery (ISGPS).
        Surgery. 2007; 142: 761-768
        • Wente M.N.
        • Veit J.A.
        • Bassi C.
        • et al.
        Postpancreatectomy hemorrhage (PPH)-An International Study Group of Pancreatic Surgery (ISGPS) definition.
        Surgery. 2007; 142: 20-25
        • Dindo D.
        • Demartines N.
        • Clavien P.A.
        Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey.
        Ann Surg. 2004; 240: 205-213
        • Palani Velu L.K.
        • Chandrabalan V.V.
        • Jabbar S.
        • et al.
        Serum amylase on the night of surgery predicts clinically significant pancreatic fistula after pancreaticoduodenectomy.
        HPB (Oxford). 2014; 16: 610-619

      Linked Article

      • Acute pancreatitis after pancreatectomy: Inside the dilemma pancreatitis-pancreatic fistula
        SurgeryVol. 169Issue 4
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          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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