Abstract
Background
Postpancreatectomy acute pancreatitis is challenging to diagnose and poorly characterized
in its early phases. However, it represents the ideal target for novel therapeutic
opportunities possibly gleaned from medical acute pancreatitis. This study aims to
systematically investigate early radiologic, biochemical, and clinical features of
postpancreatectomy acute pancreatitis.
Methods
This was a prospective observational study of patients undergoing pancreatoduodenectomy
from September 2019 to January 2021. Diffusion-weighted magnetic resonance imaging
was performed on postoperative day 3. Serum pancreatic amylase and lipase were assessed
daily until postoperative day 5. Postoperative serum hyperamylasemia and postpancreatectomy
acute pancreatitis were defined based on the International Study Group for Pancreatic
Surgery definition.
Results
A total of 65 patients were enrolled according to the sample size calculation. Patients
with postoperative serum hyperamylasemia and postpancreatectomy acute pancreatitis
had significantly lower apparent diffusion coefficient values at diffusion-weighted
magnetic resonance imaging but no macroscopic features consistent with acute pancreatitis.
Subsequently, 21 patients (32.3%) underwent computed tomography imaging for clinical
worsening, and 6 had radiologic features of acute pancreatitis. All these latter patients
had postoperative serum hyperamylasemia and worse outcomes, characterized by local
(postoperative pancreatic fistula: 83%) and systemic morbidity (sepsis: 66.7%). The
postoperative serum hyperamylasemia incidence was 21.5% (n = 14), and postpancreatectomy acute pancreatitis occurred in 6 patients (9.2%), with
4 grade B (6.1%) and 2 grade C (3%).
Conclusion
Postpancreatectomy acute pancreatitis is characterized by early serum hyperamylasemia
and hyperlipasemia. Although pancreatic changes may appear at postoperative day 3
diffusion-weighted magnetic resonance imaging, its standard use has no impact on postoperative
management. Macroscopic radiologic features appear later and correlate with worse
clinical scenarios. This paper paves the ground for including postpancreatectomy acute
pancreatitis in the spectrum of acute pancreatitis, promoting the transfer of treatment
strategies for acute pancreatitis into managing postpancreatectomy acute pancreatitis.
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Article info
Publication history
Published online: March 18, 2023
Accepted:
February 7,
2023
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 Elsevier Inc. All rights reserved.
