Pancreatic leakage and acute postoperative pancreatitis after proximal pancreatoduodenectomy
Insights
Early diagnosis of acute postoperative pancreatitis (APP) after proximal pancreatoduodenectomy (PDE) relies on clinical changes and elevated CRP/AMS levels, not CT scans. This complication significantly impacts patient survival.
Area of Science:
- Gastroenterology and Hepatology
- Surgical Oncology
- Pathology
Background:
- Acute postoperative pancreatitis (APP) is a severe complication following proximal pancreatoduodenectomy (PDE).
- Differentiating APP from pancreatic stump leak is crucial for patient management.
- Understanding the surgical treatment possibilities for APP is essential.
Purpose of the Study:
- To establish early diagnostic markers for APP after PDE.
- To differentiate APP from pancreatic stump leaks.
- To explore potential surgical interventions for APP.
Main Methods:
- Retrospective review of 160 patients undergoing PDE for pancreatic head adenocarcinoma.
- Autopsy findings used to identify histologically confirmed APP.
- Comparison of clinical, radiological, and laboratory data between APP, pancreatic leak, and uncomplicated groups.
Main Results:
- APP occurred in 4 (2.5%) patients, all of whom died.
- Significantly elevated serum pancreatic amylase (AMS) on postoperative day 1 in 3 APP patients.
- Consistently rising C-reactive protein (CRP) levels in 75% of APP patients within the first 5 days.
- CT scans up to day 5 did not reveal APP; only one case showed findings on day 9.
Conclusions:
- Abrupt clinical deterioration is the most significant indicator for early APP diagnosis post-PDE.
- Elevated CRP and AMS levels are key biochemical markers.
- CT scans are not beneficial for early APP detection; surgical options remain under consideration.
Introduction:
Acute postoperative pancreatitis (APP) after proximal pancreatoduodenectomy (PDE) is a major and serious complication. The purpose of the the study is early diagnosis of APP, differentiation from pancreatic stump leak and possibilities of surgical treatment.
Material And Methods:
Of all patients who underwent PDE for ductal adenocarcinoma of the pancreatic head complicated by type C pancreatic leak, who died during primary hospitalization, we used autopsy findings to find patients with histologically confirmed APP. We compared this group to patients with only a pancreatic leak and patients with an uncomplicated clinical course. We retrospectively evaluated the postoperative clinical course, and radiological and laboratory data of all patients. These parameters were statistically compared between the individual groups using Fisher LSD test. We considered p = 0.05 to be statistically significant. Data were analysed using software STATISTICA 10.0 (StatSoft CR s.r.o.).
Results:
One hundred sixty patients underwent PDE for ductal adenocarcinoma at our institution between 20072011 and were retrospectivaly reviewed. APP with postoperative type C pancreatic leak was observed in 4 (2.5%) patients; none of these patients survived. We found significantly higher levels of serum pancreatic amylase (AMS) on the 1. postoperative day in 3 of these patients compared to the other groups. Significantly increasing levels of CRP during the the first 5 postoperative days were observed in 75% of these patients. Retrospectively analysed contrast CT scans up to the 5th POD did not show APP. Only 1 patient had findings of APP type E according to Balthazar on CT scan performed on the 9th POD.
Conclusion:
The most significant factor in early diagnosis of APP after PDE is an abrupt change in clinical status. We also observed significantly higher levels of serum concentrations of CRP and AMS. Based on our findings, CT scan is not beneficial in the early diagnosis of APP. In cases of early diagnosed APP after PDE, the question of performing a completion pancreatectomy and its timing remains.
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