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Usefulness of Drain Lipase to Predict Postoperative Pancreatic Fistula After Distal Pancreatectomy

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Abstract

Postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP) is a worrisome and life-threatening complication. The aim of this study was to clarify the risk factors and to find the early detective method of POPF after DP. From January 2010 through December 2014, 37 patients underwent DP and were enrolled in this study to examine the factors predictive of clinical POPF after DP. POPF was defined and classified according to the International Study Group of Pancreatic Surgery guideline 2016. Biochemical leakage occurred in 14 (37.8%) patients, grade B POPF in 16 (43.2%) patients, and no grade C POPF in any patient. Clinical POPF (grade B/C) occurred in 43.2% of patients. Multivariate analysis revealed pancreatic thickness ≥ 14 mm to be the independent preoperative risk factors predictive of POPF. Receiver operating characteristic curves showed that the drain lipase ≥ 800 IU/L on postoperative day 4 could distinguish clinical POPF from non-clinical POPF effectively. Sensitivity, specificity, and accuracy were 93.8%, 70.0%, and 80.6% respectively. Pancreatic thickness ≥ 14 mm was the independent preoperative predictive risk factors for POPF. A drain lipase level of ≥800 IU/L on POD 4 was useful to find clinical POPF after DP.

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References

  1. Kawai M, Tani M, Hirono S, Ina S, Miyazawa M, Yamaue H (2009) How to we predict the clinically relevant pancreatic fistula after pancreaticoduodenectomy?-an analysis in 244 consecutive patients. World J Surg 33:2670–2678

    Article  Google Scholar 

  2. Kawai M, Kondo S, Yamaue H, Wada K, Sano K, Motoi F, Unno M, Satoi S, Kwon AH, Hatori T, Tamamoto M, Matsumoto J, Murakami Y, Doi R, Ito M, Miyakawa S, Shinchi H, Natsugoe S, Nakagawa H, Ohta T, Takada T (2011) Predictive risk factors for clinically relevant pancreatic fistula analyzed in 1,239 patients with pancreaticoduodenectomy: multicenter data collection as a project study of pancreatic surgery by the Japanese Society of Hepato-Biliary-Pancreatic Surgery. J Hepatobiliary Pancreat Sci 18:601–608

    Article  Google Scholar 

  3. Pratt WB, Callery MP, Vollmer CM Jr (2008) Risk prediction for development of pancreatic fistula using the ISGPF classification scheme. World J Surg 32:419–428

    Article  Google Scholar 

  4. Nakamura M, Wakabayashi G, Miyasaka Y, Tanaka M, Morikawa T, Unno M, TajimaH KY, Satoi S, Kwon M, Toyama H, Ku Y, Yoshitomi H, Nara S, Shimada K, Yokoyama T, Miyagawa S, Toyama Y, Yanaga K, Fujii T, Kodera Y, Study Group of JHBPS, JSEPS, Tomiyama Y, Miyata H, Takahara T, Beppu T, Yamaue H, Miyazaki M, Takada T (2015) Multicenter comparative study of laparoscopic and open distal pancreatectomy using propensity score-matching. J Hepatobiliary Pancreat Sci 22:731–736

    Article  Google Scholar 

  5. Zhang H, Zhu F, Shen M, Tian R, Shi CJ, Wang X, Jiang JX, Hu J, Wang M, Qin RY (2015) Systematic review and meta-analysis comparing three techniques for pancreatic remnant closure following distal pancreatectomy. Br J Surg 102:4–15

    Article  CAS  Google Scholar 

  6. Ban D, Shimada K, Konishi M, Saiura A, Hashimoto M, Uesaka K (2012) Stapler and nonstapler closure of the pancreatic remnant after distal pancreatectomy: multicenter retrospective analysis of 388 patients. World J Surg 36:1866–1873

    Article  Google Scholar 

  7. Hiyoshi M, Chijiiwa K, Fujii Y, Imamura N, Nagano M, Ohuchida J (2013) Usefulness of drain amylase, serum C-reactive protein levels and body temperature to predict postoperative pancreatic fistula after pancreaticoduodenectomy. World J Surg 37:2436–2442

    Article  Google Scholar 

  8. Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M, International Study Group on Pancreatic Fistula Definition (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13

    Article  Google Scholar 

  9. Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M, Allen P, Andersson R, Asbun HJ, Besselink MG, Conlon K, Del Chiaro M, Falconi M, Fernandez-Cruz L, Fernandez-Del Castillo C, Fingerhut A, Friess H, Gouma DJ, Hackert T, Izbicki J, Lillemoe KD, Neoptolemos JP, Olah A, Schulick R, Shrikhande SV, Takada T, Takatori K, Traverso W, Vollmer CR, Wolfgang CL, Yeo CJ, Salvia R, Buchler M, International Study Group on Pancreatic Surgery (ISGPS) (2017) The 2016 update of the international study group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery 161:584–591

    Article  Google Scholar 

  10. Hassenpflug M, Hinz U, Strobel O, Volpert J, Knebel P, Diener MK, Doerr-Harim C, Werner J, Hackert T, Büchler MW (2016) Teres ligament patch reduces relevant morbidity after distal pancreatectomy (the DISCOVER randomized controlled trial). Ann Surg 264:723–730

    Article  Google Scholar 

  11. Montorsi M, Zerbi A, Bassi C, Capussotti L, Coppola R, Sacchi M, Italian Tachosil Study Group (2012) Efficacy of an absorbable fibrin sealant patch (TachoSil) after distal pancreatectomy: a multicenter, randomized, controlled trial. Ann Surg 256:859–860

    Article  Google Scholar 

  12. Kawai M, Hirono S, Okada K, Sho M, Nakajima Y, Eguchi H, Nagano H, Ikoma H, Morimura R, Takeda Y, Nakahara S, Suzumura K, Fujimoto J, Yamaue H (2016) Randomized controlled trial of pancreaticojejunostomy versus stapler closure of the pancreatic stump during distal pancreatectomy to reduce pancreatic fistula. Ann Surg 264:180–187

    Article  Google Scholar 

  13. Hamilton NA, Porembka MR, Johnston FM, Gao F, Strasberg SM, Linehan DC, Hawkins WG (2012) Mesh reinforcement of pancreatic transection decreases incidence of pancreatic occlusion failure for left pancreatectomy: a single-blinded, randomized controlled trial. Ann Surg 225:1037–1042

    Article  Google Scholar 

  14. Frozanpor F, Lundell L, Segersvärd R, Arnelo U (2012) The effect of prophylactic transpapillary pancreatic stent insertion on clinically significant leak rate following distal pancreatectomy: results of a prospective controlled clinical trial. Ann Surg 255:1032–1036

    Article  Google Scholar 

  15. Allen PJ, Gönen M, Brennan MF, Bucknor AA, Robinson LM, Pappas MM, Carlucci KE, D’Angelica MI, DeMatteo RP, Kingham TP, Fong Y, Jamagin WR (2014) Pasireotide for postoperative pancreatic fistula. N Engl J Med 370:2014–2022

    Article  Google Scholar 

  16. Diener MK, Seiler CM, Rossion I, Kleeff J, Glanemann M, Butturini G, Tomazic A, Bruns CJ, Busch OR, Farkas S, Belyaev O, Neoptolemos JP, Halloran C, Keck T, Niedergethmann M, Gellert K, Witzigmann H, Kollmar O, Langer P, Steger U, Neudecker J, Berrevoet F, Ganzera S, Heiss MM, Luntz SP, Bruckner T, Kieser M, Büchler MW (2011) Efficacy of stapler versus hand-sewn closure after distal pancreatectomy (DISPACT): a randomized, controlled multicenter trial. Lancet 377:1514–1522

    Article  Google Scholar 

  17. Nakamura M, Ueda J, Kohno H, Aly MY, Takahata S, Shimizu S, Tanaka M (2011) Prolonged peri-firing compression with a linear stapler prevents pancreatic fistula in laparoscopic distal pancreatectomy. Surg Endosc 25:867–871

  18. Ecker BL, MT MM, Allegrini V, Bassi C, Beane JD, Beckman RM, Behrman SW, Dickson EJ, Callery MP, Christein JD, Drebin JA, Hollis RH, House MG, Jamieson NB, Javed AA, Kent TS, Kluger MD, Kowalsky SJ, Maggio L, Malleo G, Valero V 3rd, LKP V, Watkins AA, Wolfgang CL, Zureikat AH, Vollmer CM Jr (2017) Risk factors and mitigation strategies for pancreatic fistula after distal pancreatectomy: analysis of 2026 resections from the International, Multi-institutional Distal Pancreatectomy Study Group. Ann Surg 269:143–149

    Article  Google Scholar 

  19. Kawai M, Tani M, Okada K, Hirono S, Miyazawa M, Shimizu A, Kitahata Y, Yamaue H (2013) Stump closure of a thick pancreas using stapler closure increases pancreatic fistula after distal pancreatectomy. Am J Surg 206:352–359

    Article  Google Scholar 

  20. Peng YP, Zhu XL, Yin LD, Zhu Y, Wei JS, Wu JL, Miao Y (2017) Risk factors of postoperative pancreatic fistula in patients after distal pancreatectomy: a systematic review and meta-analysis. Sci Rep 7:185

    Article  Google Scholar 

  21. Kleff J, Diener MK, Z’graggen K, Hinz U, Wagner M, Bachmann J, Zehetner J, Müller MW, Friess H, Büchler MW (2007) Distal pancreatectomy: risk factors for surgical failure in 302 consecutive cases. Ann Surg 245:573–582

    Article  Google Scholar 

  22. Sugimoto M, Gotohda N, Kato Y, Takahashi S, Kinoshita T, Shibasaki H, Nomura S, Konishi M, Kaneko H (2013) Risk factor analysis and prevention of postoperative pancreatic fistula after distal pancreatectomy with stapler use. J Hepatobiliary Pancreat Sci 20:538–544

  23. Okano K, Oshima M, Kakinoki K, Yamamoto N, Akamoto S, Yachida S, Hagiike M, Kamada H, Masaki T, Suzuki Y (2013) Pancreatic thickness as a predictive factor for postoperative pancreatic fistula after distal pancreatectomy using an endopath stapler. Surg Today 43:141–147

  24. Chang YR, Kang JS, Jang JY. Jung WH, Kang MJ, Lee KB, Kim SW (2017) Prediction of pancreatic fistula after distal pancreatectomy based on cross-sectional images. World J Surg 41:1610–1617

  25. Kim H, Jang JY, Son D, Lee S, Han Y, Shin YC, Kim JR, Kwon W, Kim SW (2016) Optimal stapler cartridge selection according to the thickness of the pancreas in distal pancreatectomy. Medicine (Baltimore) 95:e4441

  26. Facy O, Chalumeau C, Poussier M, Binquet C, Rat P, Ortega-Deballon P (2012) Diagnosis of postoperative pancreatic fistula. Br J Surg 99:1072–1075

  27. Kong J, Gananadha S, Hugh TJ, Samra JS (2008) Pancreatoduodenectomy: role of drain fluid analysis in the management of pancreatic fistula. ANZ J Surg 78:240–244

  28. Smith RC, Southwell-Keely J, Chesher D (2005) Should serum pancreatic lipase replace serum amylase as a biomarker of acute pancreatitis? ANZ J Surg 75:399–404

  29. Kuroshima N, Tanaka T, Kuroki T, Kitasato A, Adachi T, Ono S, Matsushima H, Hirayama T, Soyama A, Hidaka M, Takatsuki M, Eguchi S (2016) Triple-drug therapy to prevent pancreatic fistula after pancreatectomy in a rat model. Pancreatology 16:917–921

  30. Van Buren G 2nd, Bloomston M, Schmidt CR, Behrman SW, Zyromski NJ, Ball CG, Morgan KA, Hughes SJ, Karanicolas PJ, Allendorf JD, Vollmer CM Jr, Ly Q, Brown KM, Velanovich V, Winter JM, McElhany AL, Muscarella P 2nd, Schmidt CM, House MG, Dixon E, Dillhoff ME, Trevino JG, Hallet J, Coburn NSG, Nakeeb A, Behrns KE, Sasson AR, Ceppa EP, Abdel-Misih SRZ, Riall TS, Silberfein EJ, Ellison EC, Adams DB, Hsu C, Tran Cao HS, Mohammed S, Villafañe-Ferriol N, Barakat O, Massarweh NN, Chai C, Mendez-Reyes JE, Fang A, Jo E, Mo Q, Fisher WE (2017) A prospective randomized multicenter trial of distal pancreatectomy with and without routine intraperitoneal drainage. Ann Surg 266:421–431

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Authors and Affiliations

  1. Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan

    Masahide Hiyoshi, Takashi Wada, Yuki Tsuchimochi, Takeomi Hamada, Koichi Yano, Naoya Imamura, Yoshiro Fujii & Atsushi Nanashima

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  1. Masahide Hiyoshi
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  2. Takashi Wada
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  3. Yuki Tsuchimochi
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  4. Takeomi Hamada
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  5. Koichi Yano
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  6. Naoya Imamura
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  7. Yoshiro Fujii
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  8. Atsushi Nanashima
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Correspondence to Masahide Hiyoshi.

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Hiyoshi, M., Wada, T., Tsuchimochi, Y. et al. Usefulness of Drain Lipase to Predict Postoperative Pancreatic Fistula After Distal Pancreatectomy. Indian J Surg 82, 841–847 (2020). https://doi.org/10.1007/s12262-020-02128-8

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  • DOI: https://doi.org/10.1007/s12262-020-02128-8

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