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Published on: March 15, 2024
Clinical characteristics and predictive factors of postoperative intra-abdominal abscess after distal pancreatectomy
Yutaka Nakano1,2, Yutaka Endo1, Minoru Kitago3
1Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan.
Purpose:
The postoperative mortality rate of distal pancreatectomy is lower than that of pancreaticoduodenectomy, although persistent complications may occur after distal pancreatectomy. Fluid collection (FC) is frequently observed after distal pancreatectomy; however, FC may occasionally progress to postoperative intra-abdominal abscess (PIAA), which requires conservative or progressive interventional treatment. This study aimed to compare the status between patients with or without PIAA, identify predictive factors for PIAA and clinically relevant postoperative pancreatic fistula, and investigate the clinical characteristics of patients with PIAA with interventional drainage.
Methods:
We retrospectively reviewed data of patients who underwent distal pancreatectomy between January 2012 and December 2019 at two high-volume centers, where hepatobiliary-pancreatic surgeries were performed by expert specialist surgeons. Logistic regression analysis was performed to determine the predictive factors for PIAA.
Results:
Overall, 242 patients were analyzed, among whom 49 (20.2%) had PIAA. The median postoperative period of PIAA formation was 9 (range: 3-49) days. Among the 49 patients with PIAA, 25 (51.0%) underwent percutaneous ultrasound, computed tomography, or endoscopic ultrasound-guided interventions for PIAA. In the univariate analysis, preoperative indices representing abdominal fat mass (i.e., body mass index, subcutaneous fat area, and visceral fat area) were identified as predictive factors for PIAA; in the multivariate analysis, C-reactive protein (CRP) level (continuous variable) on postoperative day (POD) 3 (odds ratio: 1.189, 95.0% confidence interval: 1.111 - 1.274; P < 0.001) was the only independent and significant predictive factor for PIAA.
Conclusions:
CRP level on POD 3 was an independent and significant predictive factor for PIAA after distal pancreatectomy.
Insights
Postoperative intra-abdominal abscess (PIAA) is a risk after distal pancreatectomy. C-reactive protein (CRP) levels on postoperative day 3 can predict PIAA development, guiding early intervention for better patient outcomes.
Area of Science:
- Hepatobiliary and Pancreatic Surgery
- Surgical Oncology
- Gastroenterology
Background:
- Distal pancreatectomy (DP) has a lower mortality rate than pancreaticoduodenectomy but carries risks of persistent complications.
- Fluid collection (FC) is common after DP and can progress to postoperative intra-abdominal abscess (PIAA).
- PIAA often requires intervention, making early detection crucial.
Purpose of the Study:
- To compare outcomes between patients with and without PIAA following DP.
- To identify predictive factors for PIAA and clinically relevant postoperative pancreatic fistula.
- To investigate clinical characteristics of PIAA patients requiring interventional drainage.
Main Methods:
- Retrospective review of 242 patients undergoing DP at high-volume centers (2012-2019).
- Logistic regression analysis to identify predictive factors for PIAA.
- Analysis of preoperative indices and postoperative inflammatory markers.
Main Results:
- 49 (20.2%) patients developed PIAA, with a median onset of 9 days post-surgery.
- Univariate analysis showed preoperative abdominal fat mass indices were predictive.
- Multivariate analysis identified C-reactive protein (CRP) level on postoperative day 3 as the sole independent predictor for PIAA (OR: 1.189, P < 0.001).
Conclusions:
- Elevated CRP levels on postoperative day 3 are a significant independent predictor of PIAA after distal pancreatectomy.
- This finding may aid in early identification and management of PIAA.
- Further research into intervention strategies for PIAA is warranted.
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