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Postoperative acute pancreatitis after pancreatic resection in patients with pancreatic ductal adenocarcinoma

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Abstract

Introduction

Postoperative pancreatic fistula (POPF) is one of the major critical complications after pancreatic resection. Recently, postoperative acute pancreatitis (POAP), a new concept for a pancreatic-specific complication following pancreatic resection, has been advocated, and its association with POPF has been reported. The present study examined the clinical features of POAP and identified the associations of POAP with POPF and other postoperative morbidities in pancreatic ductal adenocarcinoma (PDAC) patients undergoing pancreatic resection.

Methods

A total of 312 consecutive patients who underwent pancreatic resection for PDAC at our institution from 2013 to 2019 were enrolled in this study. POAP was defined as an elevated serum amylase level above the upper limit normal on postoperative day (POD) 0 or 1, based on Connor’s definition. The severity of POPF was assessed by the International Study Group on Pancreatic Surgery definition.

Results

A total of 184 patients (58.9%) had POAP. POAP occurred in 58.5% of subtotal stomach-preserving pancreatoduodenectomy patients and 60% of distal pancreatectomy combined with splenectomy patients. The presence of POAP was significantly associated with the development of clinically relevant POPF, higher rates of severe morbidity, and a prolonged hospital stay after pancreatic resection. A multivariate analysis showed that the presence of POAP and elevated C-reactive protein levels on POD 3 were independent predictors of clinically relevant POPF after subtotal stomach-preserving pancreatoduodenectomy.

Conclusions

POAP is associated with the development of POPF, higher rates of severe morbidity, and a prolonged hospital stay after pancreatic resection and is an independent risk factor for clinically relevant POPF after pancreatoduodenectomy. POAP represents an important indicator for planning treatment strategies to prevent serious complications, including POPF.

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Authors and Affiliations

  1. Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ward, Yokohama, 241-8515, Japan

    Masaaki Murakawa, Yuto Kamioka, Shinnosuke Kawahara, Naoto Yamamoto, Takashi Ohshima & Soichiro Morinaga

  2. Department of Hepatobiliary Pancreatic Oncology, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ward, Yokohama, 241-8515, Japan

    Satoshi Kobayashi, Makoto Ueno & Manabu Morimoto

  3. Department of Surgery, Yokohama City University School of Medicine, Yokohama, Japan

    Hiroshi Tamagawa, Norio Yukawa, Yasushi Rino & Munetaka Masuda

Authors
  1. Masaaki Murakawa
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  2. Yuto Kamioka
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Corresponding author

Correspondence to Masaaki Murakawa.

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Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Conflict of interest

Yasushi Rino has received research grants from Taiho pharmaceutical, Abbott, Asahi Kasei, Zeria pharmaceutical, Daiichi-Sankyo, Tsumura & Co., Covidien, and Otsuka. Satoshi Kobayashi has received a speaker honorarium from Bayer Yakuhin, Taiho Pharmaceutical, Yakult Honsha, Eisai, Eli Lilly, Takeda Pharmaceutical, and Chugai Pharmaceutical. Masaaki Murakawa declares that he has no conflict of interest. Yuto Kamioka declares that he has no conflict of interest. Shinnosuke Kawahara declares that he has no conflict of interest. Naoto Yamamoto declares that he has no conflict of interest. Makoto Ueno declares that he has no conflict of interest. Manabu Morimoto declares that he has no conflict of interest. Hiroshi Tamagawa declares that he has no conflict of interest. Takashi Ohshima declares that he has no conflict of interest. Norio Yukawa declares that he has no conflict of interest. Munetaka Masuda declares that he has no conflict of interest. Soichiro Morinaga declares that he has no conflict of interest.

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Murakawa, M., Kamioka, Y., Kawahara, S. et al. Postoperative acute pancreatitis after pancreatic resection in patients with pancreatic ductal adenocarcinoma. Langenbecks Arch Surg 407, 1525–1535 (2022). https://doi.org/10.1007/s00423-022-02481-0

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  • DOI: https://doi.org/10.1007/s00423-022-02481-0

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