Background: The aim of this prospective study were to clarify differences in postoperative changes of serum or drainage fluid pancreatic amylase levels and serum C-reactive protein (CRP) levels between patients with a soft pancreatic texture and those with a hard pancreatic texture undergoing pancreatoduodenectomy (PD).
Methods: A total of 55 consecutive patients with resectable periampullary tumors undergoing PD were recruited. This population was divided into 26 patients with a hard pancreatic texture and 29 patients with a soft pancreatic texture. Drainage fluid total amylase or pancreatic amylase levels, serum total amylase or pancreatic amylase levels and serum CRP levels were measured postoperatively.
Results: Serum or drainage fluid pancreatic amylase levels and serum CRP levels of patients with a soft pancreatic texture were significantly higher than those of patients with a hard pancreatic texture after PD on postoperative day 1 and 2 (P < .01). A soft pancreatic texture (P = .020) and presence of postoperative complications (P = .019) were associated significantly with higher drainage fluid amylase levels, and preoperative serum HbA1c levels (< 5.5%) (P = .007), a soft pancreatic texture (P < .001) and a pathological diagnosis of non-pancreatic carcinoma (P = .013) were associated significantly with higher postoperative serum CRP levels.
Conclusions: A soft pancreatic texture accelerates not only elevation of serum or drainage fluid pancreatic amylase levels but also systemic inflammation after PD. More careful post-PD management is needed for patients with a soft pancreatic texture.