Abstract
Background
The association between postoperative serum hyperamylasaemia (POH) and morbidity has
been hypothesized but rarely explored once occurring with or without (POH-exclusive)
a combined postoperative pancreatic fistula (POPF).
Methods
Analysis of patients who consecutively underwent pancreaticoduodenectomy from 2016
to 2020. POH was defined as serum amylase activity greater than the institutional
upper limit of normal (52 U/L), persisting within the first 48 hours postoperatively
(postoperative day [POD] 1 and 2).
Results
Among 852 patients, 15.8% developed POH-exclusive. Compared with patients without
POH or POPF (64.3%), they showed a significantly higher postoperative burden (Clavien-Dindo
≥II: 52.6% vs 30.8%) with increased rates of bacteraemia (12.6% vs 6%), pleural effusion
(13.3% vs 5.3%), postpancreatectomy haemorrhage (13.3% vs 7.5%), postpancreatectomy
acute pancreatitis (PPAP) (10.3% vs 0%), and organ site infections (18.5% vs 10.9%;
all P < .05). A total of 13.8% experienced POH with POPF leading to the worse outcome.
The combined occurrence of POH with POPF led to a shorter median time to morbidity
(3 PODs, 95% confidence interval [CI] 2.2–3.7 vs 6 PODs, 95% CI 4.2–8; P < .001) than patients experiencing POPF-exclusive (5.9%). In all, 46.6% of POH patients
developed POPF. Body mass index (BMI) (odds ratio [OR] 1.1), male sex (OR 2.1), increased
drain fluid amylase on POD 1 (OR 1.001), and increased C-reactive protein (OR 1.01)
were independent risk factors for POPF once POH has occurred.
Conclusion
POH has relevant postoperative clinical implications, independently from POPF occurrence.
Developing POH with POPF leads to an earlier onset of higher postoperative burdens.
Once POH is diagnosed, risk factors for additional POPF could identify patients who
may benefit from additional surveillance, specific drains protocols, and preventive
strategies.
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References
- Hyperamylasemia and acute pancreatitis after pancreatoduodenectomy: two different entities.Surgery. 2021; 169: 369-376
- Implications of increased serum amylase after pancreaticoduodenectomy: toward a better definition of clinically relevant postoperative acute pancreatitis.HPB (Oxford). 2020; 22: 1645-1653
- The combination of pancreas texture and postoperative serum amylase in predicting pancreatic fistula risk.Am Surg. 2018; 84: 889-896
- Postoperative hyperamylasemia (POH) and acute pancreatitis after pancreatoduodenectomy (POAP): state of the art and systematic review.Surgery. 2021; 169: 377-387
Bannone E, Marchegiani G, Balduzzi A, et al. Early and sustained elevation in serum pancreatic amylase activity: a novel predictor of morbidity after pancreatic surgery. Ann Surg. Published online April 30, 2021. https://doi.org/10.1097/SLA.0000000000004921
- Postpancreatectomy Acute Pancreatitis (PPAP): definition and grading from the International Study Group for Pancreatic Surgery (ISGPS).Ann Surg. 2022; 275: 663-672
- Postoperative acute pancreatitis following pancreaticoduodenectomy: a determinant of fistula potentially driven by the intraoperative fluid management.Ann Surg. 2018; 268: 815-822
- Defining postoperative pancreatitis as a new pancreatic specific complication following pancreatic resection.HPB (Oxford). 2016; 18: 642-651
- Postoperative serum amylase predicts pancreatic fistula formation following pancreaticoduodenectomy.J Gastrointest Surg. 2014; 18: 348-353
- Serum amylase and C-reactive protein in risk stratification of pancreas-specific complications after pancreaticoduodenectomy.Br J Surg. 2016; 103: 553-563
- Pancreatitis after pancreatoduodenectomy predicts clinically relevant postoperative pancreatic fistula.J Gastrointest Surg. 2017; 21: 330-338
- Life-threatening postoperative pancreatic fistula (grade C) after pancreaticoduodenectomy: incidence, prognosis, and risk factors.Am J Surg. 2009; 197: 702-709
- 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
- Clinical and economic validation of the International Study Group of Pancreatic Fistula (ISGPF) classification scheme.Ann Surg. 2007; 245: 443-451
- Characterization of postoperative acute pancreatitis (POAP) after distal pancreatectomy.Surgery. 2021; 169: 724-731
- Serum amylase elevation following pancreatoduodenectomy with pancreatogastrostomy is strongly associated with major complications.ANZ J Surg. 2021; 91: 348-354
- Reconstruction by pancreaticojejunostomy versus pancreaticogastrostomy following pancreatectomy: results of a comparative study.Ann Surg. 2005; 242 (discussion 771z–773): 767-771
Bassi C, Marchegiani G, Giuliani T, et al. Pancreatoduodenectomy at the Verona Pancreas Institute: the evolution of indications, surgical techniques and outcomes: a retrospective analysis of 3000 consecutive cases. Ann Surg. Published online January 15, 2021. https://doi.org/10.1097/SLA.0000000000004753
- A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy.J Am Coll Surg. 2013; 216: 1-14
- Redefining the role of drain amylase value for a risk-based drain management after pancreaticoduodenectomy: early drain removal still is beneficial.J Gastrointest Surg. 2021; 25: 1461-1470
- Amylase value in drains after pancreatic resection as predictive factor of postoperative pancreatic fistula: results of a prospective study in 137 patients.Ann Surg. 2007; 246: 281-287
- The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after.surgery. 2017; 161: 584-591
- Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS).Surgery. 2007; 142: 761-768
- Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition.Surgery. 2007; 142: 20-25
- Definition and classification of chyle leak after pancreatic operation: a consensus statement by the International Study Group on Pancreatic Surgery.Surgery. 2017; 161: 365-372
- Update on surgical site infections: the new CDC guidelines.JAAPA. 2018; 31: 52-54
- Third universal definition of myocardial infarction.J Am Coll Cardiol. 2012; 60: 1581-1598
- KDIGO clinical practice guidelines for acute kidney injury.Nephron Clin Pract. 2012; 120: c179-c184
- 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
Schuh F, Mihaljevic AL, Probst P, et al. A simple classification of pancreatic duct size and texture predicts postoperative pancreatic fistula: a classification of the International Study Group of Pancreatic Surgery (ISGPS). Ann Surg. Published online March 12, 2021. https://doi.org/10.1097/SLA.0000000000004855
- Preoperative surveillance rectal swab is associated with an increased risk of infectious complications in pancreaticoduodenectomy and directs antimicrobial prophylaxis: an antibiotic stewardship strategy?.HPB (Oxford). 2018; 20: 555-562
- Current definition of and controversial issues regarding postoperative pancreatic fistulas.Gut Liver. 2019; 13: 149-153
- Pre-, peri- and postoperative factors for the development of pancreatic fistula after pancreatic surgery.HPB (Oxford). 2019; 21: 1621-1631
- Early postoperative pancreatitis following pancreaticoduodenectomy: what is clinically relevant postoperative pancreatitis?.HPB (Oxford). 2019; 21: 972-980
- Commentary on: Postoperative acute pancreatitis.Surgery. 2021; 169: 742-743
- Invited commentary: Evolving landscape of postoperative hyperamylasemia, postoperative acute pancreatitis, and postoperative pancreatic fistula: time for a unifying definition.Surgery. 2021; 169: 740-741
- Drain management after pancreatoduodenectomy: reappraisal of a prospective randomized trial using risk stratification.J Am Coll Surg. 2015; 221: 798-809
- Predictors of pancreatic fistula healing time after distal pancreatectomy.J Hepatobiliary Pancreat Sci. 2021; 28: 1076-1088
- The golden hour: scientific fact or medical “urban legend”.Acad Emerg Med. 2001; 8: 758-760
- Vigorous periprocedural hydration with lactated ringer’s solution reduces the risk of pancreatitis after retrograde cholangiopancreatography in hospitalized patients.Clin Gastroenterol Hepatol. 2017; 15: 86-92.e1
- Lactated Ringer’s solution reduces systemic inflammation compared with saline in patients with acute pancreatitis.Clin Gastroenterol Hepatol. 2011; 9: 710-717.e1
- Guidelines for perioperative care for pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS®) Society recommendations.Clin Nutr. 2012; 31: 817-830
- Completion pancreatectomy or a pancreas-preserving procedure during relaparotomy for pancreatic fistula after pancreatoduodenectomy: a multicentre cohort study and meta-analysis.Br J Surg. 2021; 108: 1371-1379
- Early postoperative prediction of clinically relevant pancreatic fistula after pancreaticoduodenectomy: usefulness of C-reactive protein.HPB (Oxford). 2017; 19: 580-586
- Alternative Fistula Risk Score for Pancreatoduodenectomy (a-FRS): design and international external validation.Ann Surg. 2019; 269: 937-943
Marchegiani G, Perri G, Burelli A, et al. High-risk pancreatic anastomosis vs. total pancreatectomy after pancreatoduodenectomy: postoperative outcomes and quality of life analysis. Ann Surg. Published online March 4, 2021. https://doi.org/10.1097/SLA.0000000000004840
- Preoperative risk stratification of postoperative pancreatic fistula: a risk-tree predictive model for pancreatoduodenectomy.Surgery. 2021; 170: 1596-1601
Article info
Publication history
Published online: May 27, 2022
Accepted:
April 7,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
