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Pancreatitis After Pancreatoduodenectomy Predicts Clinically Relevant Postoperative Pancreatic Fistula

  • Original Article
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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Morbidity after pancreas resection is still high with postoperative pancreatic fistulas (POPF) being the most frequent complication. However, exocrine insufficiency seems to protect from POPF. In clinical practice, patients showing increased postoperative systemic amylase concentrations appear to frequently develop POPF. We therefore retrospectively examined the occurrence of systemic amylase increase after pancreas resections and its association with the clinical course.

Patients and Methods

Perioperative data from 739 consecutive pancreas resections were assessed in a prospectively maintained SPSS database. Serum and drain amylase concentrations were determined by routine clinical chemistry. POPFs were graded into A–C according to ISGPF definitions.

Results

In patients with reduced serum amylase (n = 89) on day 1 after pancreatoduodenectomy, clinically relevant POPFs were not observed. In patients with normal serum amylase concentrations, clinically relevant POPFs occurred in 9 %, while in 39 % of the patients with more than three times elevated amylase concentrations, a clinically relevant postoperative fistula was observed (p < 0.001). Systemic hyperamylasemia detected on postoperative day 1 after pancreatoduodenectomy was further a good predictor for clinically relevant POPFs (AUROC = 0.797, p < 0.001).

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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Acknowledgments

Author Contributions

U.W. and C.K. designed the study; N.S. acquired the data; N.S. analyzed the data; C.K., O.S., and F.M. interpreted the data and performed statistical analysis. C.K. and U.W. wrote the manuscript. F.M. and U.H. helped revise the manuscript. All authors discussed the data and the analysis methods and contributed to the manuscript.

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Authors and Affiliations

  1. Clinic for General and Visceral Surgery, Department of Surgery, University of Freiburg, Freiburg, Germany

    C. M. Kühlbrey, N. Samiei, O. Sick, F. Makowiec, U. T. Hopt & U. A. Wittel

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  1. C. M. Kühlbrey
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  2. N. Samiei
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  3. O. Sick
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  4. F. Makowiec
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  5. U. T. Hopt
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  6. U. A. Wittel
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Corresponding author

Correspondence to U. A. Wittel.

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No funding was received for this study.

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The authors declare that they have no conflicts of interest.

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Kühlbrey, C.M., Samiei, N., Sick, O. et al. Pancreatitis After Pancreatoduodenectomy Predicts Clinically Relevant Postoperative Pancreatic Fistula. J Gastrointest Surg 21, 330–338 (2017). https://doi.org/10.1007/s11605-016-3305-x

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  • DOI: https://doi.org/10.1007/s11605-016-3305-x

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