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Postoperative Pancreatitis After Pancreaticoduodenectomy Predicts Clinically Relevant Postoperative Pancreatic Fistulas.
Uwe A. Wittel*, Christian Kühlbrey, Niki Samiei, Frank Makowiec, Ulrich T. Hopt
Universitaestkinikum Freiburg, Freiburg, Germany
Introduction
The morbidity after pancreas resection is still high. Hereby, clinically relevant postoperative pancreatic fistulas are the most frequent complications. Risk factors for POPF development appear to be soft pancreatic tissue and a small pancreatic duct. However, the exocrine insufficiency seems to reduce the risk for POPFs and in patients with low postoperative systemic amylase concentrations the occurrence of POPS is rare. The aim of our study was to examine the predictive value of the systemic amylase concentration on the occurrence of POPFs after pancreaticoduodenectomy.
Patients and Methods
Perioperative data from 864 consecutive pancreas resections were assessed in a prospectively maintained SPSS database. Whipple resections, pylorus preserving, and laparoscopically assisted pancreaticoduodenectomies were evaluated. Serum and drain amylase concentrations were determined by routine clinical chemistry. POPFs were graded into A-C according to ISGPF definitions. In addition to descriptive statistics, chi-square and nonparametric Kruskal-Wallis-test was performed.
Results
Between all groups gender, blood loss, surgical technique was equally distributed. In patients with reduced serum amylase (n=82) on day 1 after duodenopancreatectomy, clinically relevant POPFs were not observed. In patients with normal serum amylase concentrations, POPS grade B and C occurred only in 7% while in 39% of the patients with more than 3x elevated amylase concentrations a clinically relevant postoperative fistula developed in the following postoperative course (p<0.001). Similar results were obtained for day 2 serum amylase values. The predictive value of increased serum amylase on day 1 after pancreaticoduodenectomy in receiver operated characteristic analysis showed an area under the curve of 0.888 (95%CI 0.863-0.915, p<0.001) indicating that the systemic hyperamylasia detected on day one after pancreas resections is a good predictor of clinically relevant POPFs.
Conclusion
Patients with a high risk for developing clinically relevant POPFs can be identified on the first postoperative day by determining serum amylase.
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