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Serum amylase and C-reactive protein in risk stratification of pancreas-specific complications after pancreaticoduodenectomy.

Published on Apr 1, 2016in British Journal of Surgery5.572
· DOI :10.1002/bjs.10098
L. K. Palani Velu1
Estimated H-index: 1
(Glasgow Royal Infirmary),
Colin J. McKay36
Estimated H-index: 36
(Glasgow Royal Infirmary)
+ 3 AuthorsEuan J. Dickson15
Estimated H-index: 15
(Glasgow Royal Infirmary)
Abstract
Background Pancreas-specific complications (PSCs), comprising postoperative pancreatic fistula, haemorrhage and intra-abdominal collections, are drivers of morbidity and mortality after pancreaticoduodenectomy (PD). A serum amylase concentration of 130 units/l or more on postoperative day (POD) 0 has been shown to be an objective surrogate of pancreatic texture, a determinant of PSCs. This study evaluated serial measurements of C-reactive protein (CRP) to refine PSC risk stratification. Methods Consecutive patients undergoing PD between 2008 and 2014, with vascular resection if required and without preoperative chemoradiotherapy, had serum investigations from the day before operation until discharge. Receiver operating characteristic (ROC) curve analysis was used to identify a threshold value of serum CRP with clinically relevant PSCs for up to 30 days after discharge as outcome measure. Results Of 230 patients, 95 (41·3 per cent) experienced a clinically relevant PSC. A serum CRP level of 180 mg/l or higher on POD 2 was associated with PSCs, prolonged critical care stay and relaparotomy (all P < 0·050). Patients with a serum amylase concentration of 130 units/l or more on POD 0 who developed a serum CRP level of at least 180 mg/l on POD 2 had a higher incidence of morbidity. Patients were stratified into high-, intermediate- and low-risk groups using these markers. The low-risk category was associated with a negative predictive value of 86·5 per cent for development of clinically relevant PSCs. There were no deaths among 52 patients in the low-risk group, but seven deaths among 79 (9 per cent) in the high-risk group. Conclusion A serum amylase level below 130 units/l on POD 0 combined with a serum CRP level under 180 mg/l on POD 2 constitutes a low-risk profile following PD, and may help identify patients suitable for early discharge.
  • References (35)
  • Citations (14)
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References35
Newest
#1Ven Fong ZH-Index: 1
view all 7 authors...
Abstract To perform an unbiased assessment of first postoperative day (POD 1) drain amylase level and pancreatic fistula (PF) after pancreaticoduodenectomy (PD). Recent evidence demonstrated that drain abandonment in PD is unsafe. Early drain amylase levels have been proposed as predictors of PF after PD, allowing for selection of patients for early drain removal. Daily drain amylase levels were correlated with the development of PF in 2 independent cohorts of patients undergoing PD: training co...
40 CitationsSource
#1Matthew T. McMillan (UPenn: University of Pennsylvania)H-Index: 17
#2John D. Christein (UAB: University of Alabama at Birmingham)H-Index: 29
Last. Charles M. Vollmer (UPenn: University of Pennsylvania)H-Index: 40
view all 9 authors...
Background Most accrued evidence regarding prophylactic octreotide for a pancreatoduodenectomy (PD) predates the advent of the International Study Group of Pancreatic Fistula (ISGPF) classification system for a post-operative pancreatic fistula (POPF), and its efficacy in the setting of high POPF risk is unknown. The Fistula Risk Score (FRS) predicts the risk and impact of a clinically relevant (CR)-POPF and can be useful in assessing the impact of octreotide in scenarios of risk.
37 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
#1Kenichiro Uemura (Life Sciences Institute)H-Index: 30
#2Yoshiaki Murakami (Life Sciences Institute)H-Index: 33
Last. Taijiro Sueda (Life Sciences Institute)H-Index: 38
view all 9 authors...
Background: The indicators for proper drain management following pancreaticoduodenectomy (PD) remain unclear. Our aim was to identify appropriate timing and proper indicators for safe drain management after PD. Methods: Prospectively collected data from 200 patients who underwent PD were evaluated. Postoperative clinical factors for clinically relevant pancreatic fistulas (CR‐POPFs) and management of surgically placed drains were analyzed retrospectively. Results:CR‐POPFsoccurredin8%ofpatients.B...
10 CitationsSource
#1Peter J. Allen (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 68
#2Mithat GonenH-Index: 105
Last. William R. JarnaginH-Index: 16
view all 12 authors...
Background Postoperative pancreatic fistula is a major contributor to complications and death associated with pancreatic resection. Pasireotide, a somatostatin analogue that has a longer half-life than octreotide and a broader binding profile, decreases pancreatic exocrine secretions and may prevent postoperative pancreatic fistula. Methods We conducted a single-center, randomized, double-blind trial of perioperative subcutaneous pasireotide in patients undergoing either pancreaticoduodenectomy ...
174 CitationsSource
#1George Van Buren (BCM: Baylor College of Medicine)H-Index: 18
#2Mark Bloomston (OSU: Ohio State University)H-Index: 37
Last. William E. Fisher (BCM: Baylor College of Medicine)H-Index: 42
view all 30 authors...
180 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
#1Christoph Ansorge (Karolinska University Hospital)H-Index: 10
#2Joel Z. Nordin (Karolinska University Hospital)H-Index: 12
Last. Ralf Segeravärd (Karolinska University Hospital)H-Index: 22
view all 8 authors...
Background The use of prophylactic abdominal drainage following pancreaticoduodenectomy (PD) is controversial as its therapeutic value is uncertain. However, the diagnosis of postoperative pancreatic fistula (POPF), the main cause of PD-associated morbidity, is often based on drain pancreatic amylase (DPA) levels. The aim of this study was to assess the predictive value of DPA, plasma pancreatic amylase (PPA) and serum C-reactive protein (CRP) for diagnosing POPF after PD. Methods Patients under...
28 CitationsSource
#1Benjamin C. Miller (UPenn: University of Pennsylvania)H-Index: 5
#2John D. Christein (UAB: University of Alabama at Birmingham)H-Index: 29
Last. Charles M. Vollmer (UPenn: University of Pennsylvania)H-Index: 40
view all 7 authors...
Background The Fistula Risk Score (FRS), a ten-point scale that relies on weighted influence of four variables, has been shown to effectively predict clinically relevant postoperative pancreatic fistula (CR-POPF) development and its consequences after pancreatoduodenectomy (PD). The proposed FRS demonstrated excellent predictive capacity; however, external validation of this tool would confirm its universal applicability.
79 CitationsSource
#2Murray F. BrennanH-Index: 142
Last. Peter J. AllenH-Index: 68
view all 8 authors...
Abstract The only prospective randomized trial evaluating the use of intraperitoneal drainage following pancreatic resection was published from our institution approximately 10 years ago. The current study sought to evaluate the evolution of practice over the last 5 years. Between June 2006 and June 2011, there were 1122 resections performed. Six surgeons were evenly grouped and compared by practice pattern: routine drainers (drains placed > 95%), selective drainers, and routine nondrainers (dra...
96 CitationsSource
Cited By14
Newest
#1Stefano Partelli (UniSR: Vita-Salute San Raffaele University)H-Index: 29
#2Domenico Tamburrino (Sapienza University of Rome)H-Index: 13
Last. Massimo Falconi (UniSR: Vita-Salute San Raffaele University)H-Index: 79
view all 10 authors...
Abstract Background Postoperative acute pancreatitis (POAP) can be a possible cause of postoperative pancreatic fistula (POPF). The present study aimed to evaluate the role of clinically-relevant POAP (CR-POAP), defined according to different cut-offs of postoperative amylase (AMS) values and C-reactive protein (CRP), in the development of clinically relevant POPF (CR-POPF) after pancreaticoduodenectomy (PD). Methods Data from 610 patients who underwent PD (2015–2018) were analyzed. Patients wer...
Source
Abstract Backround C-reactive protein (CRP) and procalcitonin (PCT) have shown to be reliable predictors of inflammatory complications and anastomotic leak after colorectal surgery. Their predictive value after partial pancreaticoduodenectomy (PD) remains unclear. Materials and methods All consecutive pancreaticoduodenectomies (2009–2018) at our hospital were included. Drain amylase was evaluated on postoperative day (POD) 1, serum CRP and PCT were evaluated on POD 1–3. Receiver-operating charac...
1 CitationsSource
PURPOSE: This study aimed to establish a reliable criterion for early drain removal after pancreaticoduodenectomy (PD) based on predictive factors of clinically relevant postoperative pancreatic fistula (CR-POPF) available on postoperative day 3 (POD3). METHODS: A total of 300 consecutive patients who underwent PD with pancreaticojejunostomy at our hospital from 2011 to 2015 were analyzed retrospectively. CR-POPF was defined as POPF grade B or C according to the definition by ISGPF. Clinicopatho...
Source
#1Jelle C. van Dongen (EUR: Erasmus University Rotterdam)
#2F. Jasmijn SmitsH-Index: 4
Last. Casper H.J. van Eijck (EUR: Erasmus University Rotterdam)H-Index: 51
view all 9 authors...
Abstract Background Early detection of major complications after pancreatoduodenectomy could improve patient management and decrease the “failure-to-rescue” rate. In this retrospective cohort study, we aimed to compare the value of C-reactive protein (CRP) and white blood cell count (WBC) in the early detection of complications after pancreatoduodenectomy. Methods We assessed pancreatoduodenectomies between January 2012 and December 2017. Major complications were defined as grade III or higher a...
Source
#1Haoda Chen (SJTU: Shanghai Jiao Tong University)
#2Weishen Wang (SJTU: Shanghai Jiao Tong University)H-Index: 1
Last. Baiyong Shen (SJTU: Shanghai Jiao Tong University)H-Index: 18
view all 7 authors...
Abstract Background Postoperative acute pancreatitis (POAP) after pancreaticoduodenectomy (PD) has been recently recognized as an independent complication that is associated with undesirable postoperative outcomes and often precedes other complications, yet predictive factors attributable to POAP after PD remain elusive. Methods The data from 1465 consecutive patients who underwent laparotomy or minimally invasive robotic PD from March 2010 to December 2018 were retrospectively reviewed. POAP wa...
Source
Abstract Background Prediction of complications after pancreatoduodenectomy (PD) remains of interest. Blood parameters and biomarkers during first and second postoperative days (POD1, POD2) may be early indicators of complications. Methods This case-control study included 50 patients. Baseline, POD1 and POD2 values of leukocytes, neutrophils, lymphocytes, platelets, hemoglobin, C-reactive protein (CRP), procalcitonin and arterial lactate were compared between individuals presenting Clavien ≥ III...
Source
#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
view all 7 authors...
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
#1Emrullah Birgin (Heidelberg University)H-Index: 2
#2Alina Reeg (Heidelberg University)
Last. Felix Rückert (Heidelberg University)H-Index: 19
view all 7 authors...
Abstract Background/objectives Postoperative pancreatitis (POP) has recently been shown to be the cause of pancreatic fistula (POPF) following pancreaticoduodenectomy (PD). The aim of the present study was to document the perioperative outcome associated with POP and determine potential risk factors for POP. Methods Patients undergoing PD between 2009 and 2015 were identified from the prospective data base at a single center. The previous suggested definition of POP by Connor was used. Complicat...
Source
#1Eran Sadot (TAU: Tel Aviv University)H-Index: 16
#2Jian Zheng (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 25
Last. William R. Jarnagin (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 90
view all 13 authors...
Background Organ-specific complications (OSC) remain serious potential sequela of gastrointestinal surgery. Hypophosphatemia correlates with poor outcomes and may be a harbinger of OSC after gastrointestinal surgery. Our goal was to describe and evaluate the relationship between postoperative phosphate levels and OSC.
Source
#1Dilmurodjon Eshmuminov (UZH: University of Zurich)H-Index: 6
#2Marcel André Schneider (UZH: University of Zurich)H-Index: 6
Last. P.-A. Clavien (UZH: University of Zurich)H-Index: 97
view all 8 authors...
Abstract Background In 2016, the International Study Group of Pancreatic Fistula (ISGPS) proposed an updated definition for postoperative pancreatic fistula (POPF). Pancreas texture (PT) is an established risk factor of POPF. The definition of soft vs. hard texture, however, remains elusive. Methods A systematic search was performed to identify PT definitions and a meta-analysis linking POPF to PT using the updated ISGPS definition. Results 122 studies including 22 376 patients were identified. ...
10 CitationsSource