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Can early serum lipase measurement be routinely implemented to rule out clinically significant pancreatic fistula after pancreaticoduodenectomy

Published on Sep 1, 2015in International Journal of Surgery3.158
· DOI :10.1016/j.ijsu.2015.04.090
Raffaele Dalla Valle6
Estimated H-index: 6
,
Mario De Bellis1
Estimated H-index: 1
+ 4 AuthorsM. Iaria5
Estimated H-index: 5
Sources
Abstract
Abstract Introduction Postoperative pancreatic fistula (POPF) is the most significant cause of morbidity and mortality after pancreaticoduodenectomy (PD). We evaluated the role of postoperative serum lipase concentration in ruling out POPF in the immediate post-operative period. Materials and methods We retrospectively analysed 98 consecutive PD performed between January 2009 and December 2014, investigating the correlation between postoperative day 1 (POD1) serum lipase concentration and POPF development. Results 29 patients (29.5%) developed POPF [grade A, 17 (17.3%); grade B, 8 (8.1%); grade C, 4 (4%)]. A receiver operating characteristic (ROC) analysis was conducted to determine the threshold value of POD1 serum lipase associated with clinically significant POPF (AUC = 0.76, 95% CI 0.64–0.86, P = 0.01). Such threshold was ≤44.5 U/L and its sensitivity and specificity were 92% and 66%, respectively. The positive and negative predictive values (PPV, NPV) were 31% and 98%, respectively. Conclusion Early routinely measurement of serum lipase proved to be helpful in ruling out clinically relevant POPF (CR-POPF). In our cohort, a POD1 cut-off of ≤44.5 U/L allowed early and accurate identification of patients with low probability to develop clinically significant POPF, who can eventually be selected for enhanced post-operative recovery with significant clinical and economic benefits.
  • References (21)
  • Citations (5)
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References21
Newest
#1Christina W. Lee (UW: University of Wisconsin-Madison)H-Index: 3
#2Henry A. Pitt (TU: Temple University)H-Index: 20
Last. Sharon M. Weber (UW: University of Wisconsin-Madison)H-Index: 37
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Introduction Improvements in the ability to predict pancreatic fistula could enhance patient outcomes. Previous studies demonstrate that drain fluid amylase on postoperative day 1 (DFA1) is predictive of pancreatic fistula. We sought to assess the accuracy of DFA1 and to identify a reliable DFA1 threshold under which pancreatic fistula is ruled out.
30 CitationsSource
#1Lavanniya Kumar Palani Velu (Glas.: University of Glasgow)H-Index: 4
#2Vishnu V. Chandrabalan (Glas.: University of Glasgow)H-Index: 2
Last. Euan J. Dickson (Glasgow Royal Infirmary)H-Index: 15
view all 8 authors...
Objectives Drainage after pancreaticoduodenectomy (PD) remains controversial because the risk for uncontrolled postoperative pancreatic fistula (POPF) must be balanced against the potential morbidity associated with prolonged and possibly unnecessary drainage. This study investigated the utility of the level of serum amylase on the night of surgery [postoperative day (PoD) 0 serum amylase] to predict POPF.
20 CitationsSource
#1Jacqueline S. Israel (UW: University of Wisconsin-Madison)H-Index: 6
#2Robert J. Rettammel (UW: University of Wisconsin-Madison)H-Index: 9
Last. Sharon M. Weber (UW: University of Wisconsin-Madison)H-Index: 37
view all 7 authors...
Background Previous studies suggest that after pancreatectomy, drain fluid amylase obtained on postoperative day 1 (DFA1) >5,000 U/L correlates with the development of postoperative pancreatic fistula (PF). 1,2 We sought to validate whether DFA1 is a clinically useful predictor of PF and to evaluate whether DFA1 correlates with PF severity. Study Design Using a prospective database, we reviewed records from patients having pancreatectomy between 2010 and 2012. Presence and grade of PF were deter...
26 CitationsSource
#1Jordan M. Cloyd (Stanford University)H-Index: 11
#2Zachary J. Kastenberg (Stanford University)H-Index: 13
Last. Jeffrey A. Norton (Stanford University)H-Index: 88
view all 5 authors...
Introduction Early identification of patients at risk for developing pancreatic fistula (PF) after pancreaticoduodenectomy (PD) may facilitate prevention or treatment strategies aimed at reducing its associated morbidity.
16 CitationsSource
#1M Del Chiaro (KI: Karolinska Institutet)H-Index: 23
#2Elena RangelovaH-Index: 11
Last. Ralf SegeravärdH-Index: 22
view all 5 authors...
AIM: To evaluate the impact of body mass index (BMI) on short and long term results after pancreaticoduodenectomies (PD). METHODS: A consecutive series of PDs performed at the Karolinska University Hospital from 2004 till 2010 were retrieved from our prospective database. The patients were divided by BMI into overweight/obese (O; BMI ≥ 25 kg/m2) and controls (C; BMI < 25 kg/m2). Demographics, peri-operative data, morbidity, mortality, pancreatic fistula (PF) rate, length of stay (LOS), hospital ...
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#2Thoens JonathanH-Index: 1
Last. DeVito PeterH-Index: 1
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Background The aim of this meta-analysis was to analyse the outcomes of major pancreatic surgery among the elderly (≥75 and ≥80 years of age).
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#1O. Facy (French Institute of Health and Medical Research)H-Index: 6
#2Claire ChalumeauH-Index: 3
Last. Pablo Ortega-Deballon (French Institute of Health and Medical Research)H-Index: 16
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Background: Pancreatic fistula (PF) is a major source of morbidity after pancreatectomy. The International Study Group on Pancreatic Fistula (ISGPF) defines postoperative fistula by an amylase concentration in the abdominal drain of more than three times the serum value on day 3 or more after surgery. However, this definition fails to identify some clinical fistulas. This study examined the association between lipase measured in abdominal drainage fluid and PF. Methods: Amylase and lipase levels...
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Resection of pancreas, in particular pancreaticoduodenectomy, is a complex procedure, commonly performed in appropriately selected patients with benign and malignant disease of the pancreas and periampullary region. Despite significant improvements in the safety and efficacy of pancreatic surgery, pancreaticoenteric anastomosis continues to be the “Achilles heel” of pancreaticoduodenectomy, due to its association with a measurable risk of leakage or failure of healing, leading to pancreatic fist...
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#1Robert P. SutcliffeH-Index: 18
#2Narendra BattulaH-Index: 9
Last. Andreas Prachalias (University of Cambridge)H-Index: 12
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Background Early detection of pancreatic fistula (PF) may improve the outcome after pancreaticoduodenectomy, and exclusion of PF may allow earlier drain removal and accelerate recovery. The aim of the present study was to evaluate the relationship between drain fluid amylase on the first postoperative day (DFA1) and PF.
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Acute pancreatitis is an acute inflammatory condition of the pancreas, which might extend to local and distant extrapancreatic tissues. The global incidence varies between 17.5 and 73.4 cases per 100,000 and the pathogenesis recognizes alcohol exposure and biliary tract disease as the leading causes, ahead of post-endoscopic retrograde cholangiopancreatography, drugs and abdominal trauma. The diagnosis of acute pancreatitis is substantially based on a combination of clinical signs and symptoms, ...
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Cited By5
Newest
#1F. Jasmijn Smits (UU: Utrecht University)H-Index: 4
#2Quintus Molenaar (UU: Utrecht University)H-Index: 22
Last. Hjalmar C. van Santvoort (UU: Utrecht University)H-Index: 38
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Abstract Background Early recognition of postoperative pancreatic fistula might decrease the risk of subsequent life threatening complications. The aim of this review was to systematically evaluate the accuracy of postoperative clinical, biochemical and radiologic variables for early recognition of clinically relevant postoperative pancreatic fistula. Methods A systematic literature search was performed up to August 2018. Clinical studies reporting on the association between postoperative variab...
Source
Pancreatic fistula (PF) remains the Achilles’ heel of pancreaticoduodenectomy (PD). Pancreaticogastrostomy (PG) appears to be associated with a lower risk of postoperative leak according to recent evidence. We started to fashion PG, especially in soft pancreas, modifying the original technique described by Bassi. At our institution, 105 PD procedures were carried out from January 2011 to December 2016; pancreatic-enteric continuity was restored by PG in 35 cases. Superior mesenteric/portal vein ...
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#1Théophile Guilbaud (AMU: Aix-Marseille University)H-Index: 3
#2David Jérémie Birnbaum (AMU: Aix-Marseille University)H-Index: 5
Last. Vincent Moutardier (AMU: Aix-Marseille University)H-Index: 30
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Background Postoperative pancreatic fistula and pancreas-specific complications have a significant influence on patient management and outcomes after pancreatoduodenectomy. The aim of the study was to assess the value of serum C-reactive protein on the postoperative day 1 as early predictor of pancreatic fistula and pancreas-specific complications.
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#1Christopher B. Nahm (USYD: University of Sydney)H-Index: 4
#2Kai M. Brown (USYD: University of Sydney)H-Index: 2
Last. Anubhav Mittal (USYD: University of Sydney)H-Index: 20
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Abstract Background There has been recent evidence supporting post-pancreatectomy pancreatitis as a factor in the development of postoperative pancreatic fistula (POPF). The aims of this study were to evaluate: (i) the correlation of the acinar cell density at the pancreatic resection margin with the intra-operative amylase concentration (IOAC) of peri-pancreatic fluid, postoperative pancreatitis, and POPF; and (ii) the association between postoperative pancreatitis on the first postoperative da...
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#1Saxon Connor (Christchurch Hospital)H-Index: 30
Introduction Post-operative pancreatic fistula has been well defined. However the underlying aetiology remains poorly understood. The aim of this review was to investigate whether the underlying aetiology for a proportion of patients suffering from post-operative pancreatic fistula was due to post-operative pancreatitis.
7 CitationsSource