|
1
|
Doussot B, Doussot A, Ayav A, Santucci N, Deguelte S, Sow AK, El Amrani M, Duvillard L, Piessen G, Girard E, Mabrut JY, Garnier J, Ortega-Deballon P, Fournel I, Facy O. Diagnostic Accuracy of Lipase as Early Predictor of Postoperative Pancreatic Fistula: Results from the LIPADRAIN study. ANNALS OF SURGERY OPEN 2024; 5:e492. [PMID: 39310332 PMCID: PMC11415086 DOI: 10.1097/as9.0000000000000492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2024] [Accepted: 08/07/2024] [Indexed: 09/25/2024] Open
Abstract
Objective To evaluate the diagnostic accuracy of drain fluid lipase as an early predictor of postoperative pancreatic fistula and establish the most appropriate day for their measure. Background Clinically relevant postoperative pancreatic fistula remains a potentially life-threatening complication after pancreatic surgery. Early detection strategies remain key to reduce both the incidence and the burden of pancreatic fistula. Methods The LIPAse DRAIN (LIPADRAIN) study is a multicenter, prospective diagnostic study conducted in 7 tertiary university hospitals. Drain fluid values to detect clinically relevant postoperative pancreatic fistula from postoperative day 1 to postoperative day 6 were evaluated using receiver operating characteristic curve analysis. A biomarker was considered to be relevant for clinical use if its area under the curve (AUC) was greater than 0.75. Results Of the 625 patients included in the analysis, clinically relevant postoperative pancreatic fistula occurred in 203 (32%) patients. On postoperative days 3 and 4, drain fluid lipase was a reliable biomarker to detect clinically relevant postoperative pancreatic fistula (AUC: 0.761; 95% confidence interval [CI]: 0.761-0.799 and AUC: 0.784; 95% CI: 0.743-0.821, respectively). On postoperative day 3, with a threshold of 299 units/L, drain fluid lipase yielded a negative predictive value of 51%, sensitivity of 78%, and specificity of 63% for the detection of clinically relevant postoperative pancreatic fistula. Conclusions In this multicenter prospective study, drain fluid lipase is a reliable biomarker at postoperative days 3 and 4 for the diagnosis of clinically relevant postoperative pancreatic fistula after pancreatic surgery and should be systematically measured on postoperative day 3.
Collapse
Affiliation(s)
- Béranger Doussot
- From the Department of Digestive and Surgical Oncology, University Hospital Dijon, Dijon, France
| | - Alexandre Doussot
- Department of Digestive Surgical Oncology, Liver Transplantation Unit, CHU Besancon, Besancon, France
| | - Ahmet Ayav
- Department of Hepatobiliary, Colorectal and Digestive Surgery, University of Nancy, CHU Nancy-Brabois, Nancy, France
| | - Nicolas Santucci
- From the Department of Digestive and Surgical Oncology, University Hospital Dijon, Dijon, France
| | - Sophie Deguelte
- Department of Endocrine, Digestive and Oncological Surgery, Robert-Debré University Hospital, Reims, France
| | - Amadou Khalilou Sow
- INSERM, Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, Dijon, France
| | - Mehdi El Amrani
- Department of Digestive Surgery and Liver Transplantation, Claude Huriez University Hospital, Lille, France
| | - Laurence Duvillard
- Université de Bourgogne, INSERM Research Center U1231- PADYS team, Department of Biochemistry, University Hospital Dijon, Dijon, France
- Department of Biochemistry, University Hospital Dijon, Dijon, France
| | - Guillaume Piessen
- Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France
| | - Edouard Girard
- Colorectal Unit, Department of Surgery, Grenoble Alpes University Hospital, Grenoble, France
| | - Jean-Yves Mabrut
- Department of Hepatobiliopancreatic Surgery and Liver Transplantation, Hospital Croix Rousse, Lyon, France
| | - Jonathan Garnier
- Department of Surgical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Pablo Ortega-Deballon
- From the Department of Digestive and Surgical Oncology, University Hospital Dijon, Dijon, France
| | - Isabelle Fournel
- INSERM, Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, Dijon, France
| | - Olivier Facy
- From the Department of Digestive and Surgical Oncology, University Hospital Dijon, Dijon, France
| |
Collapse
|
|
2
|
Jessernig A, Anthis AH, Vonna E, Rosendorf J, Liska V, Widmer J, Schlegel AA, Herrmann IK. Early Detection and Monitoring of Anastomotic Leaks via Naked Eye-Readable, Non-Electronic Macromolecular Network Sensors. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2400673. [PMID: 38775058 PMCID: PMC11304232 DOI: 10.1002/advs.202400673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/22/2024] [Indexed: 08/09/2024]
Abstract
Anastomotic leakage (AL) is the leaking of non-sterile gastrointestinal contents into a patient's abdominal cavity. AL is one of the most dreaded complications following gastrointestinal surgery, with mortality rates reaching up to 27%. The current diagnostic methods for anastomotic leaks are limited in sensitivity and specificity. Since the timing of detection directly impacts patient outcomes, developing new, fast, and simple methods for early leak detection is crucial. Here, a naked eye-readable, electronic-free macromolecular network drain fluid sensor is introduced for continuous monitoring and early detection of AL at the patient's bedside. The sensor array comprises three different macromolecular network sensing elements, each tailored for selectivity toward the three major digestive enzymes found in the drainage fluid during a developing AL. Upon digestion of the macromolecular network structure by the respective digestive enzymes, the sensor produces an optical shift discernible to the naked eye. The diagnostic efficacy and clinical applicability of these sensors are demonstrated using clinical samples from 32 patients, yielding a Receiver Operating Characteristic Area Under the Curve (ROC AUC) of 1.0. This work has the potential to significantly contribute to improved patient outcomes through continuous monitoring and early, low-cost, and reliable AL detection.
Collapse
Affiliation(s)
- Alexander Jessernig
- Nanoparticle Systems Engineering LaboratoryInstitute of Energy and Process Engineering (IEPE)Department of Mechanical and Process Engineering (D‐MAVT)ETH ZurichSonneggstrasse 3Zurich8092Switzerland
- Particles‐Biology Interactions LaboratoryDepartment of Materials Meet LifeSwiss Federal Laboratories for Materials Science and Technology (Empa)Lerchenfeldstrasse 5St. Gallen9014Switzerland
| | - Alexandre H.C. Anthis
- Nanoparticle Systems Engineering LaboratoryInstitute of Energy and Process Engineering (IEPE)Department of Mechanical and Process Engineering (D‐MAVT)ETH ZurichSonneggstrasse 3Zurich8092Switzerland
- Particles‐Biology Interactions LaboratoryDepartment of Materials Meet LifeSwiss Federal Laboratories for Materials Science and Technology (Empa)Lerchenfeldstrasse 5St. Gallen9014Switzerland
| | - Emilie Vonna
- Nanoparticle Systems Engineering LaboratoryInstitute of Energy and Process Engineering (IEPE)Department of Mechanical and Process Engineering (D‐MAVT)ETH ZurichSonneggstrasse 3Zurich8092Switzerland
| | - Jachym Rosendorf
- Department of SurgeryFaculty of Medicine in PilsenCharles UniversityAlej Svobody 923/80Pilsen32300Czech Republic
- Biomedical CenterFaculty of Medicine in PilsenCharles UniversityAlej Svobody 1655/76Pilsen32300Czech Republic
| | - Vaclav Liska
- Department of SurgeryFaculty of Medicine in PilsenCharles UniversityAlej Svobody 923/80Pilsen32300Czech Republic
- Biomedical CenterFaculty of Medicine in PilsenCharles UniversityAlej Svobody 1655/76Pilsen32300Czech Republic
| | - Jeannette Widmer
- Department of Surgery and TransplantationSwiss HPB CentreUniversity Hospital ZurichZürich8091Switzerland
| | - Andrea A. Schlegel
- Transplantation CenterDigestive Disease and Surgery Institute and Department of Immunity and InflammationLerner Research InstituteCleveland Clinic9620 Carnegie AveClevelandOH44106USA
| | - Inge K. Herrmann
- Nanoparticle Systems Engineering LaboratoryInstitute of Energy and Process Engineering (IEPE)Department of Mechanical and Process Engineering (D‐MAVT)ETH ZurichSonneggstrasse 3Zurich8092Switzerland
- Particles‐Biology Interactions LaboratoryDepartment of Materials Meet LifeSwiss Federal Laboratories for Materials Science and Technology (Empa)Lerchenfeldstrasse 5St. Gallen9014Switzerland
- The Ingenuity LabUniversity Hospital BalgristBalgrist CampusForchstrasse 340Zurich8008Switzerland
- Faculty of MedicineUniversity of ZurichRämistrasse 74Zürich8006Switzerland
| |
Collapse
|
|
3
|
Büyükkasap AÇ, Dikmen K, Yavuz A, Altıner S, Göbüt H, Emral AC, Bostancı H, Kerem M. Predictive value of drain fluid amylase level on postoperative day one after pancreatic resection for predicting postoperative pancreatic fistula. Turk J Surg 2024; 40:19-27. [PMID: 39036006 PMCID: PMC11257726 DOI: 10.47717/turkjsurg.2024.6292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 01/16/2024] [Indexed: 07/23/2024]
Abstract
Objectives The aim of this study was to evaluate the predictive value of the first postoperative day (POD1) drain fluid amylase in predicting pancreatic fistula formation following pancreaticoduodenectomy (PD). Material and Methods One-hundred and eighty-five prospective patients undergoing PD between April 2014 and April 2018 were studied retrospectively. Cut-off point to predict the development of POPF was determined by median values for drain fluid amylase of 1883 U/L. Patients were classified into two groups according to POD1 drain fluid amylase values: <1883 U/L (Group 1) and ≥1883 U/L (Group 2). Differences between the groups with clinically relevant POPF and without POPF were evaluated. Results The incidence of POPF was 17.2%. POD1 amylase level was the strongest predictor of POPF, with levels of higher than 1883 U/L demonstrating the best accuracy (87.5%), sensitivity (78.1%), specificity (89.5%), positive predictive value (60.9%), and negative predictive value (95.1%). One-hundred and forty-four patients (77.8%) had a POD1 drain amylase level of less than 1883 U/L, and POPF developed in only seven (3.7%) cases, whereas in patients with POD1 drain amylase level of 1883 U/L or higher (n= 41), the POPF rate was 31.4% [OR: 22.24, 95% CI (7.930-62.396), p<0.001]. Conclusion The cut-off point of POD1 drain fluid amylase level (1883 U/L) might predict the clinically relevant POPF with adequate sensitivity and specificity rates in patients undergoing pancreatic resection.
Collapse
Affiliation(s)
| | - Kürşat Dikmen
- Department of General Surgery, Gazi University Faculty of Medicine, Ankara, Türkiye
| | - Aydın Yavuz
- Department of General Surgery, Gazi University Faculty of Medicine, Ankara, Türkiye
| | - Saygın Altıner
- Department of General Surgery, Gazi University Faculty of Medicine, Ankara, Türkiye
| | - Hüseyin Göbüt
- Department of General Surgery, Gazi University Faculty of Medicine, Ankara, Türkiye
| | - Ahmet Cihangir Emral
- Department of General Surgery, Gazi University Faculty of Medicine, Ankara, Türkiye
| | - Hasan Bostancı
- Department of General Surgery, Gazi University Faculty of Medicine, Ankara, Türkiye
| | - Mustafa Kerem
- Department of General Surgery, Gazi University Faculty of Medicine, Ankara, Türkiye
| |
Collapse
|
|
4
|
Chui JN, Sahni S, Samra JS, Mittal A. Postoperative pancreatitis and pancreatic fistulae: a review of current evidence. HPB (Oxford) 2023; 25:1011-1021. [PMID: 37301633 DOI: 10.1016/j.hpb.2023.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 04/28/2023] [Accepted: 05/09/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Postoperative pancreatic fistula (POPF) represents one of the most severe complications following pancreatic surgery. Despite being a leading cause of morbidity and mortality, its pathophysiology is poorly understood. In recent years, there has been growing evidence to support the role of postoperative or post-pancreatectomy acute pancreatitis (PPAP) in the development of POPF. This article reviews the contemporary literature on POPF pathophysiology, risk factors, and prevention strategies. METHODS A literature search was conducted using electronic databases, including Ovid Medline, EMBASE, and Cochrane Library, to retrieve relevant literature published between 2005 and 2023. A narrative review was planned from the outset. RESULTS A total of 104 studies fulfilled criteria for inclusion. Forty-three studies reported on technical factors predisposing to POPF, including resection and reconstruction technique and adjuncts for anastomotic reinforcement. Thirty-four studies reported on POPF pathophysiology. There is compelling evidence to suggest that PPAP plays a critical role in the development of POPF. The acinar component of the remnant pancreas should be regarded as an intrinsic risk factor; meanwhile, operative stress, remnant hypoperfusion, and inflammation represent common mechanisms for acinar cell injury. CONCLUSIONS The evidence base for PPAP and POPF is evolving. Future POPF prevention strategies should look beyond anastomotic reinforcement and target underlying mechanisms of PPAP development.
Collapse
Affiliation(s)
- Juanita N Chui
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, Australia; Faculty of Medical and Health Sciences, The University of Sydney, Sydney, Australia
| | - Sumit Sahni
- Faculty of Medical and Health Sciences, The University of Sydney, Sydney, Australia; Kolling Institute of Medical Research, University of Sydney, Sydney, Australia
| | - Jaswinder S Samra
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, Australia; Faculty of Medical and Health Sciences, The University of Sydney, Sydney, Australia; Australian Pancreatic Centre, Sydney, Australia
| | - Anubhav Mittal
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, Australia; Faculty of Medical and Health Sciences, The University of Sydney, Sydney, Australia; Australian Pancreatic Centre, Sydney, Australia; School of Medicine, The University of Notre Dame, Sydney, Australia.
| |
Collapse
|
|
5
|
Rykina-Tameeva N, Samra JS, Sahni S, Mittal A. Drain fluid biomarkers for prediction and diagnosis of clinically relevant postoperative pancreatic fistula: A narrative review. World J Gastrointest Surg 2022; 14:1089-1106. [PMID: 36386401 PMCID: PMC9640330 DOI: 10.4240/wjgs.v14.i10.1089] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/16/2022] [Accepted: 10/14/2022] [Indexed: 02/07/2023] Open
Abstract
Clinically relevant postoperative pancreatic fistula (CR-POPF) has continued to compromise patient recovery post-pancreatectomy despite decades of research seeking to improve risk prediction and diagnosis. The current diagnostic criteria for CR-POPF requires elevated drain fluid amylase to present alongside POPF-related complications including infection, haemorrhage and organ failure. These worrying sequelae necessitate earlier and easily obtainable biomarkers capable of reflecting evolving CR-POPF. Drain fluid has recently emerged as a promising source of biomarkers as it is derived from the pancreas and hence, capable of reflecting its postoperative condition. The present review aims to summarise the current knowledge of CR-POPF drain fluid biomarkers and identify gaps in the field to invigorate future research in this critical area of clinical need. These findings may provide robust diagnostic alternatives for CR-POPF and hence, to clarify their clinical utility require further reports detailing their diagnostic and/or predictive accuracy.
Collapse
Affiliation(s)
| | - Jaswinder S Samra
- Northern Clinical School, University of Sydney, St Leonards 2065, Australia
| | - Sumit Sahni
- Northern Clinical School, University of Sydney, St Leonards 2065, Australia
| | - Anubhav Mittal
- Northern Clinical School, University of Sydney, St Leonards 2065, Australia
| |
Collapse
|
|
6
|
Hassan RA, Zidan A, Jabir MA, Abdelshafy M, Abdallah M, Taha AM. Risk factors predicting the development of a pancreatic fistula following pancreaticoduodenectomy: A retrospective cohort study. INTERNATIONAL JOURNAL OF SURGERY OPEN 2022. [DOI: 10.1016/j.ijso.2022.100509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
|
7
|
Kowal M, Bolton W, Van Duren B, Burke J, Jayne D. Impact of surgical drain output monitoring on patient outcomes in hepatopancreaticobiliary surgery: A systematic review. Scand J Surg 2022; 111:14574969211030118. [PMID: 34749548 DOI: 10.1177/14574969211030118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVE Surgical drains are widely utilized in hepatopancreaticobiliary surgery to prevent intra-abdominal collections and identify postoperative complications. Surgical drain monitoring ranges from simple-output measurements to specific analysis for constituents such as amylase. This systematic review aimed to determine whether surgical drain monitoring can detect postoperative complications and impact on patient outcomes. METHODS A systematic review was performed, and the following databases searched between 02/03/20 and 26/04/20: MEDLINE, EMBASE, The Cochrane Library, and Clinicaltrials.gov. All studies describing surgical drain monitoring of output and content in adult patients undergoing hepatopancreaticobiliary surgery were considered. Other invasive methods of intra-abdominal sampling were excluded. RESULTS The search returned 403 articles. Following abstract review, 390 were excluded and 13 articles were included for full review. The studies were classified according to speciality and featured 11 pancreatic surgery and 2 hepatobiliary surgery studies with a total sample of 3262 patients. Postoperative monitoring of drain amylase detected pancreatic fistula formation and drain bilirubin testing facilitated bile leak detection. Both methods enabled early drain removal. Improved patient outcomes were observed through decreased incidence of postoperative complications (pancreatic fistulas, intra-abdominal infections, and surgical-site infections), length of stay, and mortality rate. Isolated monitoring of drain output did not confer any clinical benefits. CONCLUSIONS Surgical drain monitoring has advantages in the postoperative care for selected patients undergoing hepatopancreaticobiliary surgery. Enhanced surgical drain monitoring involving the testing of drain amylase and bilirubin improves the detection of complications in the immediate postoperative period.
Collapse
Affiliation(s)
- Mikolaj Kowal
- The John Goligher Colorectal Surgery Unit, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds LS9 7TF, West Yorkshire, UK NIHR Surgical MedTech Co-operative, St James's University Hospital, Leeds, UK University of Leeds, Leeds, UK
| | - William Bolton
- The John Goligher Colorectal Surgery Unit, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- NIHR Surgical MedTech Co-operative, St James's University Hospital, Leeds, UK
- University of Leeds, Leeds, UK
| | - Bernard Van Duren
- University of Leeds, Leeds, UKLeeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, UK
| | - Joshua Burke
- The John Goligher Colorectal Surgery Unit, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- NIHR Surgical MedTech Co-operative, St James's University Hospital, Leeds, UK
- University of Leeds, Leeds, UK
| | - David Jayne
- The John Goligher Colorectal Surgery Unit, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- NIHR Surgical MedTech Co-operative, St James's University Hospital, Leeds, UK
- University of Leeds, Leeds, UK
| |
Collapse
|
|
8
|
Koek S, Wiegele S, Ballal M. Drain fluid amylase and lipase as a predictive factor of postoperative pancreatic fistula. ANZ J Surg 2021; 92:414-418. [PMID: 34676961 DOI: 10.1111/ans.17296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/01/2021] [Accepted: 10/01/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Early detection of a postoperative pancreatic fistula (POPF) may improve outcomes after pancreaticoduodenectomy (PD). The aim was to assess the role of postoperative drain fluid amylase (DFA) and lipase (DFL) measurements as a predictive indicator in the development of POPF. METHODS This retrospective cohort study included all PD procedures performed between 2009 and 2017 at Fremantle and Fiona Stanley Hospital in Western Australia. The DFA and DFL measurements on postoperative day (POD) three and five were correlated with the development of POPF. RESULTS A total of 169 patients were included in this study with a mean age of 64 ± 11.3 years. Of these, 17 (10.1%) developed a clinically significant POPF. In patients who had both a DFA and DFL measured on both POD 3 and 5, DFA and DFL was significantly higher in patients who developed POPF than those who did not (P < 0.001). In a receiver operating characteristic curve analysis, the most accurate test was POD 3 DFL measurement with an AUC 0.85 (CI 0.75-0.95, P < 0.001). A negative predictive value of 97.4% was observed. DFA and DFL were concordant in 89.2% of cases on POD 3 and 90.6% of cases on POD 5. CONCLUSION In this study, DFL measured on POD 3 as a single measurement appears to carry the most benefit in prediction of clinically significant POPF. Reduction to a measurement on this day may lead to a reduction in cost, earlier drain removal and earlier identification of high-risk patients.
Collapse
Affiliation(s)
- Sharnice Koek
- Department of General Surgery, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.,Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Sophie Wiegele
- Department of General Surgery, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Mohammed Ballal
- Department of General Surgery, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.,Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| |
Collapse
|
|
9
|
Giovinazzo F, Linneman R, Riva GVD, Greener D, Morano C, Patijn GA, Besselink MGH, Nieuwenhuijs VB, Abu Hilal M, de Hingh IH, Kazemier G, Festen S, de Jong KP, van Eijck CHJ, Scheepers JJG, van der Kolk M, den Dulk M, Bosscha K, Boerma D, van der Harst E, Armstrong T, Takhar A, Hamady Z. Clinical relevant pancreatic fistula after pancreatoduodenectomy: when negative amylase levels tell the truth. Updates Surg 2021; 73:1391-1397. [PMID: 33770412 DOI: 10.1007/s13304-021-01020-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 03/02/2021] [Indexed: 11/29/2022]
Abstract
Drain Amylase level are routinely determined to diagnose pancreatic fistula after Pancreatocoduodenectomy. Consensus is lacking regarding the cut-off value of amylase to diagnosis clinically relevant postoperative pancreatic fistulae (POPF). The present study proposes a model based on Amylase Value in the Drain (AVD) measured in the first three postoperative days to predict a POPF. Amylase cut-offs were selected from a previous published systematic review and the accuracy were validated in a multicentre database from 12 centres in 2 countries. The present study defined POPF the 2016 ISGPS criteria (3 times the upper limit of normal serum amylase). A learning machine method was used to correlate AVD with the diagnosis of POPF. Overall, 454 (27%) of 1638 patients developed POPF. Machine learning excluded a clinically relevant postoperative pancreatic fistulae with an AUC of 0.962 (95% CI 0.940-0.984) in the first five postoperative days. An AVD at a cut-off of 270 U/L in 2 days in the first three postoperative days excluded a POPF with an AUC of 0.869 (CI 0.81-0.90, p < 0.0001). A single AVD in the first three postoperative days may not exclude POPF after pancreatoduodenectomy. The levels should be monitored until day 3 and have two negative values before removing the drain. In the group with a positive level, the drain should be kept in and AVD monitored until postoperative day five.
Collapse
Affiliation(s)
- Francesco Giovinazzo
- Department of Surgery, University Hospital of Southampton NHS Foundation Trust, E Level, Tremona Road, Southampton, SO166YD, UK.,General Surgery and Liver Transplant Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Ralph Linneman
- Department of Surgery, Isala Clinics, Zwolle, The Netherlands
| | | | | | - Christopher Morano
- Master of Data Science, University of British Columbia, Vancouver, Canada
| | - Gijs A Patijn
- Department of Surgery, Isala Clinics, Zwolle, The Netherlands
| | - Mark G H Besselink
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Mohammad Abu Hilal
- Department of Surgery, University Hospital of Southampton NHS Foundation Trust, E Level, Tremona Road, Southampton, SO166YD, UK. .,Department of Surgery, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
10
|
Suzuki S, Shimoda M, Shimazaki J, Oshiro Y, Nishida K, Shiihara M, Izumo W, Yamamoto M. Drain Lipase Levels and Decreased Rate of Drain Amylase Levels as Independent Predictors of Pancreatic Fistula with Nomogram After Pancreaticoduodenectomy. World J Surg 2021; 45:1921-1928. [PMID: 33721069 DOI: 10.1007/s00268-021-06038-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Pancreaticoduodenectomy (PD) has recently been improved due to its increased safety. However, postoperative pancreatic fistula (POPF) remains a lethal complication of PD. Identifying novel clinicophysiological risk factors for POPF during the early post-PD period would help improve patient morbidity and mortality. Therefore, this retrospective study aimed to evaluate possible risk factors during the early postoperative period after pancreaticoduodenectomy (PD). METHODS Data from 349 patients who underwent PD between 2007 and 2012 were examined retrospectively. All patients were classified into 2 groups: group A, patients without fistulae or biochemical leaks (288 patients), and group B, those with grade B or C POPF (61 patients). Data on various clinicophysiological parameters, including serum and drain laboratory data, were collected. Univariate and multivariate analyses were performed to evaluate POPF predictors. A predictive nomogram was established for these results. RESULTS Univariate analysis showed that various serum and drain-related factors, such as white blood cell count, C-reactive protein levels, drain amylase (DAMY) levels, and drain lipase (DLIP) levels, were possible POPF risk factors. Multivariate analysis confirmed that postoperative day (POD) 1 DLIP levels (hazard ratio, 15.393; p = 0.037) and decreased rate (POD3/1) of DAMY levels (hazard ratio, 4.415; p = 0.028) were independent risk factors. Further, POD1 DLIP levels and decreased rate of DAMY levels were significantly lower in group A than in group B. The accuracy of nomogram was 0.810. CONCLUSIONS POD1 DLIP levels (> 245 U/mL) and decreased rate of DAMY levels (> 0.44) were POPF risk factors, making them possible biomarkers for POPF.
Collapse
Affiliation(s)
- Shuji Suzuki
- Department of Gastroenterological Surgery, Ibaraki Medical Center, Tokyo Medical University, 3-20-1 Chuo, Amimachi, Inashikigun, Ibaraki, 300-0395, Japan.
| | - Mitsugi Shimoda
- Department of Gastroenterological Surgery, Ibaraki Medical Center, Tokyo Medical University, 3-20-1 Chuo, Amimachi, Inashikigun, Ibaraki, 300-0395, Japan
| | - Jiro Shimazaki
- Department of Gastroenterological Surgery, Ibaraki Medical Center, Tokyo Medical University, 3-20-1 Chuo, Amimachi, Inashikigun, Ibaraki, 300-0395, Japan
| | - Yukio Oshiro
- Department of Gastroenterological Surgery, Ibaraki Medical Center, Tokyo Medical University, 3-20-1 Chuo, Amimachi, Inashikigun, Ibaraki, 300-0395, Japan
| | - Kiyotaka Nishida
- Department of Gastroenterological Surgery, Ibaraki Medical Center, Tokyo Medical University, 3-20-1 Chuo, Amimachi, Inashikigun, Ibaraki, 300-0395, Japan
| | - Masahiro Shiihara
- Department of Gastroenterological Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Wataru Izumo
- Department of Gastroenterological Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Masakazu Yamamoto
- Department of Gastroenterological Surgery, Tokyo Women's Medical University, Tokyo, Japan
| |
Collapse
|
|
11
|
Tzedakis S, Sauvanet A, Schiavone R, Razafinimanana M, Cauchy F, Rouet J, Dousset B, Gaujoux S. What should we trust to define, predict and assess pancreatic fistula after pancreatectomy? Pancreatology 2020; 20:1779-1785. [PMID: 33077382 DOI: 10.1016/j.pan.2020.10.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/04/2020] [Accepted: 10/08/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The ISGPF postoperative pancreatic fistula (POPF) definition using amylase drain concentration is widely used. However, the interest of lipase drain concentration, daily drain output and absolute enzyme daily production (concentration x daily drain volume) have been poorly investigated. MATERIAL AND METHODS These predictive on postoperative day (POD) 1, 3, 5 and 7 were analyzed in a development cohort, and subsequently tested in an independent validation cohort. RESULTS Of the 227 patients of the development cohort, 17% developed a biochemical fistula and 34% a POPF (Grade B/C). Strong correlation was found between amylase/lipase drain concentration at all postoperative days (ρ = 0.90; p = 0.001). Amylase and lipase were both significantly higher in patients with a POPF (p < 0.001) presenting an equivalent under the ROC curve area (0.85 vs 0.84; p = 0.466). Combining POD1 and POD3 threefold enzyme cut-off value increased significantly POPF prediction sensibility (97.4% vs 77.8%) and NPV (97.1% vs 86.3%). These results were also confirmed in the validation cohort of 554 patients. Finally, absolute enzyme daily production and daily drain output were significantly higher in patients with a POPF (p < 0.001) but did not add clinical value when compared to drain enzyme concentration. CONCLUSION Lipase is as effective as amylase drain concentration to define POPF. Absolute enzyme daily production or daily drain output do not help to better predict clinically significant POPF occurrence and severity. Lipase and amylase should mainly be used for their negative predictive value to predict the absence of clinically significant POPF and could allow early drain removal and hospital discharge.
Collapse
Affiliation(s)
- Stylianos Tzedakis
- Department of Digestive, Pancreatic, Hepato-biliary and Endocrine Surgery, Cochin Hospital, APHP, Paris, France
| | - Alain Sauvanet
- Department of Hepato-Pancreato-Biliary Surgery, Pôle des Maladies de l'Appareil Digestif (PMAD), Hospital Beaujon, APHP, Clichy, France; University of Paris, Paris, France
| | - Roberto Schiavone
- Department of Digestive, Pancreatic, Hepato-biliary and Endocrine Surgery, Cochin Hospital, APHP, Paris, France
| | - Meva Razafinimanana
- Department of Digestive, Pancreatic, Hepato-biliary and Endocrine Surgery, Cochin Hospital, APHP, Paris, France
| | - François Cauchy
- Department of Hepato-Pancreato-Biliary Surgery, Pôle des Maladies de l'Appareil Digestif (PMAD), Hospital Beaujon, APHP, Clichy, France; University of Paris, Paris, France
| | - Jérémy Rouet
- Department of Digestive, Pancreatic, Hepato-biliary and Endocrine Surgery, Cochin Hospital, APHP, Paris, France; Department of Hepato-Pancreato-Biliary Surgery, Pôle des Maladies de l'Appareil Digestif (PMAD), Hospital Beaujon, APHP, Clichy, France
| | - Bertrand Dousset
- Department of Digestive, Pancreatic, Hepato-biliary and Endocrine Surgery, Cochin Hospital, APHP, Paris, France; University of Paris, Paris, France
| | - Sébastien Gaujoux
- Department of Digestive, Hepato-biliary and Endocrine Surgery, La Pitié-Salpétrière Hospital, APHP, Paris, France; Médecine Sorbonne Université, Paris, France.
| |
Collapse
|
|
12
|
Hiraki M, Miyoshi A, Sadashima E, Shinkai Y, Yasunami M, Manabe T, Kitahara K, Noshiro H. The novel early predictive marker presepsin for postoperative pancreatic fistula: A pilot study. Exp Ther Med 2020; 20:2298-2304. [PMID: 32765708 DOI: 10.3892/etm.2020.8919] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 03/26/2020] [Indexed: 12/13/2022] Open
Abstract
Postoperative pancreatic fistula (PF) is a major and serious complication that occurs after pancreaticoduodenectomy (PD). The aim of the current study was to evaluate the use of a novel biomarker, presepsin, for predicting clinically relevant postoperative pancreatic fistula (CR-POPF) after PD. A prospective pilot study was conducted using 30 consecutive patients who underwent PD. Risk factors and candidates for predictive biomarkers for CR-POPF were statistically analyzed. CR-POPF (grade B and C; determined according to the guidelines of the International Study Group of Pancreatic Fistula) occurred in 15 patients (50%). Univariate analysis revealed that certain underlying conditions, including non-pancreatic cancer, smaller pancreatic ducts and soft pancreas texture were significantly associated with CR-POPF (P=0.005, P=0.004 and P=0.014, respectively). Furthermore, on day 1 post surgery (POD1), white blood cell count (P=0.040), levels of serum amylase (P=0.002) and serum presepsin (P=0.012), and the concentration of presepsin in drainage fluid (P<0.001) were significantly increased in CR-POPF compared with non-CR-POPF cases. Receiver operating characteristic curve analyses revealed that, on POD1, serum amylase and the concentration of presepsin in drainage fluid had an area under the curve value exceeding 0.8. A multivariate logistic regression analysis revealed that a higher concentration of presepsin in the drainage fluid was an independent predictive marker for CR-POPF (odds ratio, 14.503; 95% confidence interval, 1.750-120.229; P=0.013). To the best of our knowledge, the present study demonstrated for the first time that presepsin concentration in drainage fluid is a useful marker of CR-POPF after PD.
Collapse
Affiliation(s)
- Masatsugu Hiraki
- Department of Surgery, Saga Medical Center Koseikan, Saga 840-8571, Japan
| | - Atsushi Miyoshi
- Department of Surgery, Saga Medical Center Koseikan, Saga 840-8571, Japan
| | - Eiji Sadashima
- Life Science Research Institution, Saga Medical Center Koseikan, Saga 840-8571, Japan
| | - Yukio Shinkai
- Clinical Laboratory, Saga Medical Center Koseikan, Saga 840-8571, Japan
| | - Michio Yasunami
- Clinical Laboratory, Saga Medical Center Koseikan, Saga 840-8571, Japan
| | - Tatsuya Manabe
- Department of Surgery, Saga University Faculty of Medicine, Saga 849-8501, Japan
| | - Kenji Kitahara
- Department of Surgery, Saga Medical Center Koseikan, Saga 840-8571, Japan
| | - Hirokazu Noshiro
- Department of Surgery, Saga University Faculty of Medicine, Saga 849-8501, Japan
| |
Collapse
|
|
13
|
Usefulness of Drain Lipase to Predict Postoperative Pancreatic Fistula After Distal Pancreatectomy. Indian J Surg 2020. [DOI: 10.1007/s12262-020-02128-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
|
|
14
|
Smits FJ, Molenaar IQ, Besselink MG, Borel Rinkes IHM, van Eijck CHJ, Busch OR, van Santvoort HC. Early recognition of clinically relevant postoperative pancreatic fistula: a systematic review. HPB (Oxford) 2020; 22:1-11. [PMID: 31445782 DOI: 10.1016/j.hpb.2019.07.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 06/14/2019] [Accepted: 07/13/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Early recognition of postoperative pancreatic fistula might decrease the risk of subsequent life threatening complications. The aim of this review was to systematically evaluate the accuracy of postoperative clinical, biochemical and radiologic variables for early recognition of clinically relevant postoperative pancreatic fistula. METHODS A systematic literature search was performed up to August 2018. Clinical studies reporting on the association between postoperative variables and clinically relevant postoperative pancreatic fistula were included. Variables were stratified: early prediction (postoperative day 1-2) versus early diagnosis (day 3) and had to be reported in 2 cohorts. RESULTS Overall, 37 included studies reported on 17 different diagnostic variables after 8701 pancreatic resections. Clinically relevant postoperative pancreatic fistula occurred in 1532/8701 patients (18%). Early prediction variables included elevated serum and drain amylase (day 1). Identified variables for early diagnosis were: non-serous drain efflux (day 3); positive drain culture (day 3); elevated temperature (any day); elevated C-Reactive Protein (CRP; day 4); elevated white blood cell count (day 4) and peripancreatic collections on computed tomography (CT; day 5-10). CONCLUSION This review provides a comprehensive overview of postoperative variables associated with clinically relevant pancreatic fistula. Incorporation of variables in future algorithms could potentially mitigate the clinical impact of postoperative pancreatic fistula.
Collapse
Affiliation(s)
- F Jasmijn Smits
- Dept. of Surgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584CX, Utrecht, the Netherlands
| | - I Quintus Molenaar
- Dept. of Surgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584CX, Utrecht, the Netherlands; Dept. of Surgery, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, the Netherlands
| | - Marc G Besselink
- Dept. of Surgery, Amsterdam UMC, Cancer Center Amsterdam, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Inne H M Borel Rinkes
- Dept. of Surgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584CX, Utrecht, the Netherlands
| | - Casper H J van Eijck
- Dept. of Surgery, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, the Netherlands
| | - Olivier R Busch
- Dept. of Surgery, Amsterdam UMC, Cancer Center Amsterdam, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Hjalmar C van Santvoort
- Dept. of Surgery, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584CX, Utrecht, the Netherlands; Dept. of Surgery, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, the Netherlands.
| |
Collapse
|
|
15
|
Müssle B, Oehme F, Schade S, Sommer M, Bogner A, Hempel S, Pochhammer J, Kahlert C, Distler M, Weitz J, Welsch T. Drain Amylase or Lipase for the Detection of POPF-Adding Evidence to an Ongoing Discussion. J Clin Med 2019; 9:jcm9010007. [PMID: 31861508 PMCID: PMC7019284 DOI: 10.3390/jcm9010007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/11/2019] [Accepted: 12/16/2019] [Indexed: 01/08/2023] Open
Abstract
Objectives: A postoperative pancreatic fistula (POPF) is defined as a threefold increase in the amylase concentration in abdominal drains on or after the third postoperative day (POD). However, additional lipase fluid analysis is widely used despite lacking evidence. In this study, drain amylase and lipase levels were compared regarding their value in detecting POPF. Methods: We conducted a retrospective study including all patients who underwent pancreatic resections at our center between 2005 and 2016. Drain fluid analysis was performed from day 2 to 5. Results: 990 patients were included in the analysis. Overall, 333 (34%) patients developed a POPF. The median amylase and lipase concentrations at POD 3 in cases with POPF were 11.55 µmol/(s·L) (≈13 ×-fold increase) and 39 µmol/(s·L) (≈39 ×-fold increase), respectively. Seven patients with subsequent POPF (2%) were missed with amylase analysis on POD 3, but detected using 3-fold lipase analysis. The false-positive rate of lipase was 51/424 = 12%. A cutoff lipase value at POD 3 of > 4.88 yielded a specificity of 94% and a sensitivity of 89% for development of a POPF. Increased body mass index turned out as risk factor for the development of POPF in a multivariable model. Conclusions: Threefold-elevated lipase concentration may be used as an indicator of a POPF. However, the additional detection of POPF using simultaneous lipase analysis is marginal. Therefore, assessment of lipase concentration does not provide added clinical value and only results in extra costs.
Collapse
Affiliation(s)
- Benjamin Müssle
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, 01307 TU Dresden, Germany; (B.M.); (F.O.); (S.S.); (M.S.); (A.B.); (S.H.); (C.K.); (M.D.); (J.W.)
| | - Florian Oehme
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, 01307 TU Dresden, Germany; (B.M.); (F.O.); (S.S.); (M.S.); (A.B.); (S.H.); (C.K.); (M.D.); (J.W.)
| | - Stephanie Schade
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, 01307 TU Dresden, Germany; (B.M.); (F.O.); (S.S.); (M.S.); (A.B.); (S.H.); (C.K.); (M.D.); (J.W.)
| | - Marian Sommer
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, 01307 TU Dresden, Germany; (B.M.); (F.O.); (S.S.); (M.S.); (A.B.); (S.H.); (C.K.); (M.D.); (J.W.)
| | - Andreas Bogner
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, 01307 TU Dresden, Germany; (B.M.); (F.O.); (S.S.); (M.S.); (A.B.); (S.H.); (C.K.); (M.D.); (J.W.)
| | - Sebastian Hempel
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, 01307 TU Dresden, Germany; (B.M.); (F.O.); (S.S.); (M.S.); (A.B.); (S.H.); (C.K.); (M.D.); (J.W.)
| | - Julius Pochhammer
- Department of General, Visceral, Thoracic, Transplant, and Pediatric Surgery, University Hospital Schleswig-Holstein, 24105 Kiel, Germany;
| | - Christoph Kahlert
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, 01307 TU Dresden, Germany; (B.M.); (F.O.); (S.S.); (M.S.); (A.B.); (S.H.); (C.K.); (M.D.); (J.W.)
| | - Marius Distler
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, 01307 TU Dresden, Germany; (B.M.); (F.O.); (S.S.); (M.S.); (A.B.); (S.H.); (C.K.); (M.D.); (J.W.)
| | - Jürgen Weitz
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, 01307 TU Dresden, Germany; (B.M.); (F.O.); (S.S.); (M.S.); (A.B.); (S.H.); (C.K.); (M.D.); (J.W.)
| | - Thilo Welsch
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, 01307 TU Dresden, Germany; (B.M.); (F.O.); (S.S.); (M.S.); (A.B.); (S.H.); (C.K.); (M.D.); (J.W.)
- Correspondence: ; Tel.: +49-(0)351-458-18283
| |
Collapse
|
|
16
|
Jiang L, Ning D, Chen X. Prevention and treatment of pancreatic fistula after pancreatic body and tail resection: current status and future directions. Front Med 2019; 14:251-261. [PMID: 31840199 DOI: 10.1007/s11684-019-0727-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 10/12/2019] [Indexed: 02/08/2023]
Abstract
Postoperative pancreatic fistula (POPF) is the most common and critical complication after pancreatic body and tail resection. How to effectively reduce the occurrence of pancreatic fistula and conduct timely treatment thereafter is an urgent clinical issue to be solved. Recent research standardized the definition of pancreatic fistula and stressed the correlation between POPF classification and patient prognosis. According to the literature, identification of the risk factors for pancreatic fistula contributed to lowering the rate of the complication. Appropriate management of the pancreatic stump and perioperative treatment are of great significance to reduce the rate of POPF in clinical practice. After the occurrence of POPF, the treatment of choice should be determined according to the classification of the pancreatic fistula. However, despite the progress and promising treatment approaches, POPF remains to be a clinical issue that warrants further studies in the future.
Collapse
Affiliation(s)
- Li Jiang
- Department of Biliary and Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Deng Ning
- Department of Biliary and Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xiaoping Chen
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
| |
Collapse
|
|
17
|
Roy M, Ban EJ, Mohandas S, Mownah O, Banerjee A, Kocher H, Bhattacharya S, Hutchins R. Re: Comparison of lipase and amylase for diagnosing post-operative pancreatic fistulae. ANZ J Surg 2018; 88:1213-1214. [DOI: 10.1111/ans.14890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 08/30/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Mayank Roy
- Barts and the London HPB Centre; The Royal London Hospital, Barts Health NHS Trust; London UK
| | - Ee Jun Ban
- Barts and the London HPB Centre; The Royal London Hospital, Barts Health NHS Trust; London UK
| | - Shailesh Mohandas
- Barts and the London HPB Centre; The Royal London Hospital, Barts Health NHS Trust; London UK
| | - Omar Mownah
- Barts and the London HPB Centre; The Royal London Hospital, Barts Health NHS Trust; London UK
| | - Abhirup Banerjee
- Barts and the London HPB Centre; The Royal London Hospital, Barts Health NHS Trust; London UK
| | - Hemant Kocher
- Barts and the London HPB Centre; The Royal London Hospital, Barts Health NHS Trust; London UK
| | - Satya Bhattacharya
- Barts and the London HPB Centre; The Royal London Hospital, Barts Health NHS Trust; London UK
| | - Robert Hutchins
- Barts and the London HPB Centre; The Royal London Hospital, Barts Health NHS Trust; London UK
| |
Collapse
|
|
18
|
Griffith D, Hanna T, Wong K, Reece-Smith A, Aroori S, Bowles M, Stell D, Briggs C. Comparison of lipase and amylase for diagnosing post-operative pancreatic fistulae. ANZ J Surg 2018; 88:751-754. [PMID: 29882290 DOI: 10.1111/ans.14266] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 08/17/2017] [Accepted: 08/20/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND To ascertain if post-operative drain fluid lipase is superior to amylase in routinely detecting clinically significant post-operative pancreatic fistulae (POPF). METHOD Between January 2015 and March 2016 data were collected on all patients undergoing pancreatic surgery at a regional referral centre. Routine drain fluid analysis was performed on post-operative patients as part of a locally defined enhanced recovery protocol. POPF was diagnosed in accordance with the recently updated International Study Group of Pancreatic Surgery guidance. RESULTS During the study period, there were 68 pancreatic resections. The median age was 69.1 years. A total of 11 (15.9%) patients developed clinically significant POPF (nine type B and two type C). The median drain amylase result in patients with type B or C leak was 532 IU/L (interquartile range (IQR) 264-833). This was significantly higher than those without a clinical fistula (median 38, IQR 15-376, P = 0.012). The median drain lipase result was 1504 IU/L (IQR 746-2236). This was significantly higher than those without a clinical fistula (median 57, IQR 13-1277, P = 0.012). Fluid amylase had a sensitivity of 81.8% and specificity of 69.2%; fluid lipase had a sensitivity of 91% and specificity of 64.9%. CONCLUSION Our experience suggests drain fluid amylase or lipase results are not sufficiently sensitive or specific to reassure clinicians and rule out clinically significant POPF. However, if biochemical tests are used to aid decision-making, then lipase is a more sensitive biochemical marker than amylase for the routine detection of clinically significant POPF.
Collapse
Affiliation(s)
- David Griffith
- Department of HPB Surgery, Derriford Hospital, Plymouth, UK
| | - Thomas Hanna
- Department of HPB Surgery, Derriford Hospital, Plymouth, UK
| | - Kimberley Wong
- Department of HPB Surgery, Derriford Hospital, Plymouth, UK
| | | | - Somaiah Aroori
- Department of HPB Surgery, Derriford Hospital, Plymouth, UK
| | - Matthew Bowles
- Department of HPB Surgery, Derriford Hospital, Plymouth, UK
| | - David Stell
- Department of HPB Surgery, Derriford Hospital, Plymouth, UK
| | | |
Collapse
|
|
19
|
Xing H, Zhang L, Ma J, Liu Z, Song C, Liu Y. Fructus mume Extracts Alleviate Diarrhea in Breast Cancer Patients Receiving the Combination Therapy of Lapatinib and Capecitabine. Front Pharmacol 2018; 9:516. [PMID: 29875660 PMCID: PMC5974171 DOI: 10.3389/fphar.2018.00516] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 04/30/2018] [Indexed: 12/12/2022] Open
Abstract
Lapatinib and capecitabine have been widely used in the therapy of breast cancer. However, long-term use of lapatinib and capecitabine often causes the most common side effect diarrhea, which limit the medicine use. Fructus mume (F. mume) has been proved to be effective to treat chronic diarrhea with few side effects. The compounds from F. mume were extracted by using an ethanol method. Extracts of F. mume (EFM) were analyzed by HPLC. We investigated the protective effects of EFM on the diarrhea caused by lapatinib and capecitabine. From March 1st, 2016 to June 1st, 2017, 208 breast cancer patients with diarrhea caused by lapatinib and capecitabine were recruited. The patients were evenly assigned into two groups: EG group (the patients took 100 mg EFM daily) and CG group (the patients took placebo daily). The effects of EFM on diarrhea and gastrointestinal symptoms were measured by a semiquantitative method seven-point Likert scale. Overall quality of life was measured by SF-36 questionnaire and Hospital Anxiety and Depression Scale (HADS). The HPLC analysis showed that there were three components in EFM, including citric acid, 5-hydroxymethylfurfural (5-HMF), and chlorogenic acid. Breast cancer types were observed by using Hematoxylin and eosin (H&E) stain. The breast cancer can be divided into leaflet, gland and fibroblast types. Patient age, skin metastases, treatment, and grade 1 diarrhea were significant risk factors associated with for grade 2 diarrhea. EFM reduced diarrhea and gastrointestinal symptoms by reducing the average scores of the diarrhea symptom and seven-point Likert scale, and improved life quality of patients significantly by improving SF-36 scores and reducing HADS scores when compared to that in the CG group after 6-week therapy and further 4-week follow-up (P < 0.05). EFM may be a potential choice for the diarrhea therapy in breast cancer patients.
Collapse
Affiliation(s)
- Hua Xing
- Department of Breast Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Lirong Zhang
- Department of Pathology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Jinshu Ma
- Department of Pathology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Zhen Liu
- Pediatrics, Liuhe District Hospital of Nanjing, Nanjing, China
| | - Changlong Song
- Department of Breast Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Yuxia Liu
- Archives Center, China-Japan Union Hospital of Jilin University, Changchun, China
| |
Collapse
|
|
20
|
Chen BP, Bennett S, Bertens KA, Balaa FK, Martel G. Use and acceptance of the International Study Group for Pancreatic Fistula (ISGPF) definition and criteria in the surgical literature. HPB (Oxford) 2018; 20:69-75. [PMID: 28927654 DOI: 10.1016/j.hpb.2017.08.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 08/07/2017] [Accepted: 08/13/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND The level of utilization and acceptance of the 2005 International Study Group for Pancreatic Fistula (ISGPF) definition for postoperative pancreatic fistula (POPF) has not be quantified. The aim of this study was to determine the uptake of the ISGPF definition and evaluate its use in the surgical literature. METHODS A sample of primary studies, review articles, and textbooks were identified through screening of literature searches. Included citations were assessed for their definition of POPF and use of the ISGPF criteria. RESULTS From 2006 to 2009, 6%-63% of primary papers were compliant with the ISGPF definition compared to 84%-98% from 2010 onwards. Of the primary studies compliant with the ISGPF criteria, 36% focused on grade B and C fistula and 15% did not report grade A fistula. 88% of European papers used the criteria compared to 77% and 72% of Asian and North American papers, respectively (p = 0.033). 46% of review articles and textbooks did not define POPF. Among those that defined POPF, 74% cited the ISGPF definition exclusively while 26% mentioned other definitions. CONCLUSION The ISGPF criteria have been widely adopted and accepted as the standard for defining POPF, although the utility of grade A fistulas is questionable.
Collapse
Affiliation(s)
- Brian P Chen
- Liver and Pancreas Unit, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Sean Bennett
- Liver and Pancreas Unit, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Kimberly A Bertens
- Liver and Pancreas Unit, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Fady K Balaa
- Liver and Pancreas Unit, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
| | - Guillaume Martel
- Liver and Pancreas Unit, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
| |
Collapse
|
|
21
|
Clinical and pathological outcomes after irreversible electroporation of the pancreas using two parallel plate electrodes: a porcine model. HPB (Oxford) 2017; 19:1058-1065. [PMID: 29029985 DOI: 10.1016/j.hpb.2017.02.443] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 02/02/2017] [Accepted: 02/28/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Irreversible electroporation (IRE) by inserting needles around the tumor as treatment for locally advanced pancreatic cancer entails several disadvantages, such as incomplete ablation due to field inhomogeneity, technical difficulties in needle placement and a risk of pancreatic fistula development. This experimental study evaluates outcomes of IRE using paddles in a porcine model. METHODS Six healthy pigs underwent laparotomy and were treated with 2 separate ablations (in head and tail of the pancreas). Follow-up consisted of clinical and laboratory parameters and contrast-enhanced computed tomography (ceCT) imaging. After 2 weeks, pancreatoduodenectomy was performed for histology and the pigs were terminated. RESULTS All animals survived 14 days. None of the animals developed signs of infection or significant abdominal distention. Serum amylase and lipase peaked at day 1 postoperatively in all pigs, but normalized without signs of pancreatitis. On ceCT-imaging the ablation zone was visible as an ill-defined, hypodense lesion. No abscesses, cysts or ascites were seen. Histology showed a homogenous fibrotic lesion in all pigs. CONCLUSION IRE ablation of healthy porcine pancreatic tissue using two plate electrodes is feasible and safe and creates a homogeneous fibrotic lesion. IRE-paddles should be tested on pancreatic adenocarcinoma to determine the effect in cancer tissue.
Collapse
|
|
22
|
Wang H, Xiu D, Tao M. The pancreatic juice length in the stent tube as the predicting factor of clinical relevant postoperative pancreatic fistula after pancreaticoduodenectomy. Medicine (Baltimore) 2017; 96:e8451. [PMID: 29095290 PMCID: PMC5682809 DOI: 10.1097/md.0000000000008451] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Several risk factors for pancreatic fistula had been widely reported, but there was no research focusing on the exocrine output of remnant gland.During the study period of January 2015 to September 2016, 82 patients accepted pancreaticoduodenectomy (PD, end-to-end dunking pancreaticojejunostomy with internal stent tube). All the data were collected, including preoperative medical status, operative course, final pathology, gland texture, pancreatic duct diameter, size of the stent, length of pancreatic juice in the stent tube, width of the pancreatic stump, diameter of the jejunum and the status of postoperative pancreatic fistula (POPF). POPF was defined according to International Study Group of Pancreatic Fistula criteria.The diameter of pancreatic duct in the POPF group was significantly smaller than that in the group without POPF (1.99 vs 2.90 mm, P = .000). The length of pancreatic juice in the stent tube in the POPF group was significantly longer than that in the group without POPF (18.04 vs 6.92 cm, P = .014). There were more pancreatic ductal adenocarcinoma cases and hard glands in the group without POPF. The length of pancreatic juice in the clinically relevant postoperative pancreatic fistula (CR-POPF) group was significantly longer than that in the grade A group (32.4 vs 9.21 cm, P = .000). Multivariate analysis identified gland texture and length of pancreatic juice as independent predictors for pancreatic fistula. Multivariate analysis also identified the length of pancreatic juice as an independent predictor for CR-POPF.The length of pancreatic juice in the stent tube might be a useful predictive factor of POPF after PD, especially for CR-POPF.
Collapse
|
|
23
|
Jwa EK, Hwang S. Extended pancreatic transection for secure pancreatic reconstruction during pancreaticoduodenectomy. Ann Hepatobiliary Pancreat Surg 2017; 21:138-145. [PMID: 28990000 PMCID: PMC5620474 DOI: 10.14701/ahbps.2017.21.3.138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 08/11/2017] [Accepted: 08/17/2017] [Indexed: 12/30/2022] Open
Abstract
Backgrounds/Aims Pancreaticoduodenectomy (PD) is associated with various surgical complications including healing failure of the pancreaticojejunostomy (PJ). This study intended to ensure blood supply to the pancreatic stump through extended pancreatic transection (EPT). Methods This study assessed whether EPT reduces PJ-associated complications and whether EPT is harmful on the remnant pancreatic function. The EPT group included 19 patients undergoing PD, pylorus-preserving PD (PPPD) or hepatopancreaticoduodenectomy. The propensity score matched control group included 45 patients who had undergone PPPD. Pancreatic transection was performed at the level of the celiac axis in the EPT group, by which the pancreatic body was additionally removed by 3 cm in length comparing with the conventional pancreatic transection. Results A small invagination fissure suspected as the embryonic fusion site was identified at the ventro-caudal edge of the pancreatic body in all patients undergoing EPT. A sizable fissure permitting easy separation of the pancreatic parenchyma was identified in 15 of 19 patients (78.9%). The incidence of significant postoperative pancreatic fistula was significantly lower in the EPT group than in the control group (p=0.047). There was no significant increase in the postoperative de novo diabetes mellitus in EPT group (p=0.60). Conclusions The EPT technique contributes to the prevention of major pancreatic fistula without impairing remnant pancreatic function. EPT is feasible for routine clinical application or at least in patients with any known risk of PJ leak.
Collapse
Affiliation(s)
- Eun-Kyoung Jwa
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Shin Hwang
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
|
24
|
Davidson TB, Yaghoobi M, Davidson BR, Gurusamy KS, Cochrane Upper GI and Pancreatic Diseases Group. Amylase in drain fluid for the diagnosis of pancreatic leak in post-pancreatic resection. Cochrane Database Syst Rev 2017; 4:CD012009. [PMID: 28386958 PMCID: PMC6478074 DOI: 10.1002/14651858.cd012009.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The treatment of people with clinically significant postoperative pancreatic leaks is different from those without clinically significant pancreatic leaks. It is important to know the diagnostic accuracy of drain fluid amylase as a triage test for the detection of clinically significant pancreatic leaks, so that an informed decision can be made as to whether the patient with a suspected pancreatic leak needs further investigations and treatment. There is currently no systematic review of the diagnostic test accuracy of drain fluid amylase for the diagnosis of clinically relevant pancreatic leak. OBJECTIVES To determine the diagnostic accuracy of amylase in drain fluid at 48 hours or more for the diagnosis of pancreatic leak in people who had undergone pancreatic resection. SEARCH METHODS We searched MEDLINE, Embase, the Science Citation Index Expanded, and the National Institute for Health Research Health Technology Assessment (NIHR HTA) websites up to 20 February 2017. We searched the references of the included studies to identify additional studies. We did not restrict studies based on language or publication status, or whether data were collected prospectively or retrospectively. We also performed a 'related search' and 'citing reference' search in MEDLINE and Embase. SELECTION CRITERIA We included all studies that evaluated the diagnostic test accuracy of amylase in the drain fluid at 48 hours or more for the diagnosis of pancreatic leak in people who had undergone pancreatic resection excluding total pancreatectomy. We planned to exclude case-control studies because these studies are prone to bias, but did not find any. At least two authors independently searched and screened the references produced by the search to identify relevant studies. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data from the included studies. The included studies reported drain fluid amylase on different postoperative days and measured at different cut-off levels, so it was not possible to perform a meta-analysis using the bivariate model as planned. We have reported the sensitivity, specificity, post-test probability of a positive and negative drain fluid amylase along with 95% confidence interval (CI) on each of the different postoperative days and measured at different cut-off levels. MAIN RESULTS A total of five studies including 868 participants met the inclusion criteria for this review. The five studies included in this review reported the value of drain fluid amylase at different thresholds and different postoperative days. The sensitivities and specificities were variable; the sensitivities ranged between 0.72 and 1.00 while the specificities ranged between 0.73 and 0.99 for different thresholds on different postoperative days. At the median prevalence (pre-test probability) of 15.9%, the post-test probabilities for pancreatic leak ranged between 35.9% and 95.4% for a positive drain fluid amylase test and ranged between 0% and 5.5% for a negative drain fluid amylase test.None of the studies used the reference standard of confirmation by surgery or by a combination of surgery and clinical follow-up, but used the International Study Group on Pancreatic Fistula (ISGPF) grade B and C as the reference standard. The overall methodological quality was unclear or high in all the studies. AUTHORS' CONCLUSIONS Because of the paucity of data and methodological deficiencies in the studies, we are uncertain whether drain fluid amylase should be used as a method for testing for pancreatic leak in an unselected population after pancreatic resection; and we judge that the optimal cut-off of drain fluid amylase for making the diagnosis of pancreatic leak is also not clear. Further well-designed diagnostic test accuracy studies with pre-specified index test threshold of drain fluid amylase (at three times more on postoperative day 5 or another suitable pre-specified threshold), appropriate follow-up (for at least six to eight weeks to ensure that there are no pancreatic leaks), and clearly defined reference standards (of surgical, clinical, and radiological confirmation of pancreatic leak) are important to reliably determine the diagnostic accuracy of drain fluid amylase in the diagnosis of pancreatic leak.
Collapse
Affiliation(s)
| | - Mohammad Yaghoobi
- McMaster University and McMaster University Health Sciences CentreDivision of Gastroenterology1200 Main Street WestHamiltonONCanada
| | - Brian R Davidson
- Royal Free Campus, UCL Medical SchoolDepartment of SurgeryPond StreetLondonUKNW3 2QG
| | | | | |
Collapse
|
|
25
|
Hamano N, Murata M, Kawano T, Piao JS, Narahara S, Nakata R, Akahoshi T, Ikeda T, Hashizume M. Förster Resonance Energy Transfer-Based Self-Assembled Nanoprobe for Rapid and Sensitive Detection of Postoperative Pancreatic Fistula. ACS APPLIED MATERIALS & INTERFACES 2016; 8:5114-5123. [PMID: 26845508 DOI: 10.1021/acsami.5b11902] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Postoperative pancreatic fistula (POPF) is the most serious and challenging complication following gastroenterological surgery. Activated pancreatic juice leaking from the organ remnant contains proteases that attack the surrounding tissue, potentially leading to severe inflammation, tissue necrosis, and fistula formation. However, it is difficult to observe pancreatic leakage during surgery and to evaluate the protease activity of leaked fluid at the patient's bedside. This report describes a protein nanocage-based protease ratiometric sensor comprising a pancreatic protease-sensitive small heat-shock protein (HSP) 16.5, which is a naturally occurring protein in Methanococcus jannaschii that forms a spherical structure by self-assembly of 24 subunits, and a chemically conjugated donor-acceptor dye pair for Förster resonance energy transfer (FRET). The HSP-FRET probe was constructed by subunit exchange of each dye-labeled engineered HSP, resulting in a spherical nanocage of approximately 10 nm in diameter, which exhibited very high stability against degradation in blood plasma and no remarkable toxicity in mice. The efficiency of FRET was found to depend on both the dye orientation and the acceptor/donor ratio. Pancreatic proteases, including trypsin, α-chymotrypsin, and elastase, were quantitatively analyzed by fluorescence recovery with high specificity using the HSP-FRET nanoprobe. Furthermore, the HSP-FRET nanoprobe was sufficiently sensitive to detect POPF in the pancreatic juice of patients using only the naked eye within 10 min. Thus, this novel nanoprobe is proposed as an effective and convenient tool for the detection of POPF and the visualization of activated pancreatic juice during gastroenterological surgery.
Collapse
Affiliation(s)
- Nobuhito Hamano
- Center for Advanced Medical Innovation, ‡Department of Advanced Medical Initiatives, Faculty of Medical Sciences, and §Innovation Center for Medical Redox Navigation, Kyushu University , 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Masaharu Murata
- Center for Advanced Medical Innovation, ‡Department of Advanced Medical Initiatives, Faculty of Medical Sciences, and §Innovation Center for Medical Redox Navigation, Kyushu University , 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Takahito Kawano
- Center for Advanced Medical Innovation, ‡Department of Advanced Medical Initiatives, Faculty of Medical Sciences, and §Innovation Center for Medical Redox Navigation, Kyushu University , 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Jing Shu Piao
- Center for Advanced Medical Innovation, ‡Department of Advanced Medical Initiatives, Faculty of Medical Sciences, and §Innovation Center for Medical Redox Navigation, Kyushu University , 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Sayoko Narahara
- Center for Advanced Medical Innovation, ‡Department of Advanced Medical Initiatives, Faculty of Medical Sciences, and §Innovation Center for Medical Redox Navigation, Kyushu University , 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Ryosuke Nakata
- Center for Advanced Medical Innovation, ‡Department of Advanced Medical Initiatives, Faculty of Medical Sciences, and §Innovation Center for Medical Redox Navigation, Kyushu University , 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Tomohiko Akahoshi
- Center for Advanced Medical Innovation, ‡Department of Advanced Medical Initiatives, Faculty of Medical Sciences, and §Innovation Center for Medical Redox Navigation, Kyushu University , 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Tetsuo Ikeda
- Center for Advanced Medical Innovation, ‡Department of Advanced Medical Initiatives, Faculty of Medical Sciences, and §Innovation Center for Medical Redox Navigation, Kyushu University , 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Makoto Hashizume
- Center for Advanced Medical Innovation, ‡Department of Advanced Medical Initiatives, Faculty of Medical Sciences, and §Innovation Center for Medical Redox Navigation, Kyushu University , 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| |
Collapse
|
|
26
|
Bor R, Madácsy L, Fábián A, Szepes A, Szepes Z. Endoscopic retrograde pancreatography: When should we do it? World J Gastrointest Endosc 2015; 7:1023-1031. [PMID: 26322155 PMCID: PMC4549659 DOI: 10.4253/wjge.v7.i11.1023] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Revised: 06/30/2015] [Accepted: 08/14/2015] [Indexed: 02/05/2023] Open
Abstract
Endoscopic retrograde pancreatography (ERP) is an accurate imaging modality in the diagnosis of pancreatobiliary diseases. However, its use has been substantially reduced due to the invasiveness of procedure, the risk of complications and the widespread availability of non-invasive cross-section imaging techniques (computed tomography, magnetic resonance imaging, and endoscopic ultrasound). Since the introduction of endoscopic sphincterotomy, ERP has transformed from diagnostic method to an almost exclusively therapeutic procedure. Pancreatic duct injection substantially increased the risk of post-ERP pancreatitis (1.6%-15.7%); therefore, according to international guidelines ERP is recommended only in cases where biliary intervention is required. However, the role of ERP in the management of pancreatic diseases is currently not clearly defined, but in some cases the filling of pancreatic duct may provide essential information complementing the results of non-invasive imaging techniques. The aim of this publication is to systematically summarize the literature dealing with the diagnostic yield of ERP. We would like to define the precise indications of ERP and overview a diagnostic protocol of pancreatic diseases depending on international guidelines and the opinion of Hungarian experts, because it may improve the diagnostic accuracy, minimize of burden of patients and reduce the risk of procedure related complications.
Collapse
|
|
27
|
Yang J, Huang Q, Wang C. Postoperative drain amylase predicts pancreatic fistula in pancreatic surgery: A systematic review and meta-analysis. Int J Surg 2015. [PMID: 26211439 DOI: 10.1016/j.ijsu.2015.07.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND OBJECTIVES This study to evaluate the utility of drain fluid amylase as a predictor of PF in patients undergoing pancreatic surgery based on the International Study Group of Pancreatic Fistula definitions of pancreatic fistula. METHODS A comprehensive search was carried out using Pubmed (Medline), Embase, Web of science and Cochrane database for clinical trials, which studied DFA as a diagnostic marker for pancreatic fistula after pancreatic surgery. Sensitivity, specificity and the diagnostic odds ratios with 95% confidence interval were calculated for each study. Summary receiver-operating curves were conducted and the area under the curve was evaluated. RESULTS A total of 10 studies were included. The pooled sensitivity and specificity of drain fluid amylase Day 1 for the diagnosis of postoperative pancreatic fistula were 81% and 87%, respectively (area under the curve was 0.897, diagnostic odds ratios was 16.83 and 95%CI was 12.66-22.36), the pooled sensitivity and specificity of drain fluid amylase Day 3 for the diagnosis of postoperative pancreatic fistula were 56% and 79%, respectively (area under the curve was 0.668, diagnostic odds ratios was 3.26 and 95%CI was 1.83-5.82) CONCLUSIONS: The drain fluid amylase Day 1, instead of drain fluid amylase Day 3, may be a useful criterion for the early identification of postoperative pancreatic fistula, and a value of drain fluid amylase Day 1 over than 1300 U/L was a risk factor of pancreatic fistula. And the diagnostic accuracy and the proposed cut-off levels of drain fluid amylase Day 1 in predicting the postoperative pancreatic fistula will have to be validated by multicenter prospective studies.
Collapse
Affiliation(s)
- Ji Yang
- Department of General Surgery, Affiliated Provincial Hospital of Anhui Medical University, Hefei 230001, China; Hepatobiliary and Pancreatic Laboratory of Anhui Province, Hefei 230001, China.
| | - Qiang Huang
- Department of General Surgery, Affiliated Provincial Hospital of Anhui Medical University, Hefei 230001, China; Hepatobiliary and Pancreatic Laboratory of Anhui Province, Hefei 230001, China.
| | - Chao Wang
- Department of General Surgery, Affiliated Provincial Hospital of Anhui Medical University, Hefei 230001, China; Hepatobiliary and Pancreatic Laboratory of Anhui Province, Hefei 230001, China
| |
Collapse
|
|
28
|
Yoon YI, Hwang S, Cho YJ, Ha TY, Song GW, Jung DH. Therapeutic effect of trans-drain administration of antibiotics in patients showing intractable pancreatic leak-associated pus drainage after pancreaticoduodenectomy. KOREAN JOURNAL OF HEPATO-BILIARY-PANCREATIC SURGERY 2015; 19:17-24. [PMID: 26155272 PMCID: PMC4494091 DOI: 10.14701/kjhbps.2015.19.1.17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 02/10/2015] [Accepted: 02/19/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUNDS/AIMS To cope with intractable pus drainage from persistent pancreatic leak after pancreaticoduodenectomy (PD), we have empirically performed local administration of high-concentration antibiotics cocktail solution into abdominal drains. The purpose of this study was to assess its therapeutic effect in patients showing intractable pus drainage after PD. METHODS The study group was 10 patients who underwent trans-drain administration of high-concentration antibiotics cocktail solution. Another 10 patients were selected through propensity score matching for the control group. Their medical records were retrospectively reviewed with focus on comparison of pancreatic fistula (PF)-associated clinical sequences. RESULTS Postoperative PF of grade B and C occurred in 7 and 3 patients in the study group and 9 and 1 patient in the control group, respectively (p=0.58). In the study group, a mean of 1.8 sessions of antibiotics cocktail solution (imipenem 500 mg and vancomycin 500 mg dissolved in 20 ml of normal saline) was administered. Two patients showed procedure-associated febrile episodes that were spontaneously controlled within 48 hours. At 2-4 days after the first-session of antibiotics administration, pus-like drain discharge turned to be serous with significantly decreased amount. The study group showed shortened postoperative hospital stay comparing to the control group (25.2±4.6 vs. 31.8±5.6 days, p=0.011). In both groups, no patient received radiological or surgical intervention due to PF-associated complications. CONCLUSIONS The results of our study demonstrated that trans-drain administration of antibiotics could be an effective therapeutic option for pancreaticojejunostomy leak-associated infection. Further validation of our result is necessary in large patient populations from multiple centers.
Collapse
Affiliation(s)
- Young-In Yoon
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Shin Hwang
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yu-Jeong Cho
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Yong Ha
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gi-Won Song
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong-Hwan Jung
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
|
29
|
Dalla Valle R, De Bellis M, Pedrazzi G, Lamecchi L, Bianchi G, Pellegrino C, Iaria M. Can early serum lipase measurement be routinely implemented to rule out clinically significant pancreatic fistula after pancreaticoduodenectomy? Int J Surg 2015; 21 Suppl 1:S50-4. [PMID: 26118616 DOI: 10.1016/j.ijsu.2015.04.090] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 03/24/2015] [Accepted: 04/10/2015] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Postoperative pancreatic fistula (POPF) is the most significant cause of morbidity and mortality after pancreaticoduodenectomy (PD). We evaluated the role of postoperative serum lipase concentration in ruling out POPF in the immediate post-operative period. MATERIALS AND METHODS We retrospectively analysed 98 consecutive PD performed between January 2009 and December 2014, investigating the correlation between postoperative day 1 (POD1) serum lipase concentration and POPF development. RESULTS 29 patients (29.5%) developed POPF [grade A, 17 (17.3%); grade B, 8 (8.1%); grade C, 4 (4%)]. A receiver operating characteristic (ROC) analysis was conducted to determine the threshold value of POD1 serum lipase associated with clinically significant POPF (AUC = 0.76, 95% CI 0.64-0.86, P = 0.01). Such threshold was ≤ 44.5 U/L and its sensitivity and specificity were 92% and 66%, respectively. The positive and negative predictive values (PPV, NPV) were 31% and 98%, respectively. CONCLUSION Early routinely measurement of serum lipase proved to be helpful in ruling out clinically relevant POPF (CR-POPF). In our cohort, a POD1 cut-off of ≤ 44.5 U/L allowed early and accurate identification of patients with low probability to develop clinically significant POPF, who can eventually be selected for enhanced post-operative recovery with significant clinical and economic benefits.
Collapse
Affiliation(s)
| | - Mario De Bellis
- Department of Surgery, Parma University Hospital, Parma, Italy.
| | - Giuseppe Pedrazzi
- Department of Neuroscience, Parma University Hospital, Parma, Italy.
| | - Laura Lamecchi
- Department of Surgery, Parma University Hospital, Parma, Italy.
| | - Giorgio Bianchi
- Department of Surgery, Parma University Hospital, Parma, Italy.
| | | | - Maurizio Iaria
- Department of Surgery, Parma University Hospital, Parma, Italy.
| |
Collapse
|
|
30
|
Jin K, Zhou H, Zhang J, Wang W, Sun Y, Ruan C, Hu Z, Wang Y. Systematic review and meta-analysis of somatostatin analogues in the prevention of postoperative complication after pancreaticoduodenectomy. Dig Surg 2015; 32:196-207. [PMID: 25872003 DOI: 10.1159/000381032] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Accepted: 02/15/2015] [Indexed: 01/04/2023]
Abstract
BACKGROUND The use of somatostatin analogues (SAs) following pancreaticoduodenectomy (PD) is controversial. METHOD Literature databases were searched systematically for relevant articles. A meta-analysis of all randomized controlled trials (RCTs) evaluating prophylactic SAs in PD was performed. RESULTS Fifteen RCTs involving 1,352 patients were included. There was a towards reduced incidences of pancreatic fistulas (p = 0.26), clinically significant pancreatic fistulas (p = 0.08), and bleeding (p = 0.05) in prophylactic SAs group. In subgroup analyses, prophylactic somatostatin significantly reduced the incidence of pancreatic fistulas(p = 0.02), with a nonsignificant trend toward reduced incidence of clinically significantly pancreatic fistulas (p = 0.06).Pasireotide significantly reduced the incidence of clinically significantly pancreatic fistulas (p = 0.03). Octreotide had no influence on the incidence of pancreatic fistulas. CONCLUSION The current best evidence suggests prophylactic treatment with somatostatin or pasireotide has a potential role in reducing the incidence of pancreatic fistulas, while octreotide had no influence on the incidence of pancreatic fistulas.High-quality RCTs assessing the role of somatostatin and pasireotide are required for further verification.
Collapse
|
|
31
|
Yoo D, Hwang S, Kim KH, Ahn CS, Moon DB, Ha TY, Jung DH, Park GC, Jung BH, Kang SH, Lee SG. Pancreatic atrophy relative to external versus internal drainage of the pancreatic duct after pylorus-preserving pancreaticoduodenectomy. J Gastrointest Surg 2014; 18:1604-9. [PMID: 25002021 DOI: 10.1007/s11605-014-2583-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Accepted: 06/20/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Atrophy of the pancreatic parenchyma, which occurs frequently after pylorus-preserving pancreaticoduodenectomy (PPPD), is often associated with pancreatic exocrine insufficiency. Many surgeons prefer to insert a drainage tube into the remnant pancreatic duct primarily to prevent pancreatic leakage at the pancreaticojejunostomy (PJ) after PPPD. Drainage methods vary widely but can be roughly classified as internal or external drainage. This study intended to evaluate their effects on pancreatic parenchymal atrophy following PPPD. METHODS Fifty-seven patients who underwent PPPD were retrospectively divided into two groups, 28 who underwent external and 29 who underwent internal pancreatic drainage. External drainage tubes were removed 4 weeks after PPPD. The volume of the pancreatic parenchyma was serially measured on abdominal computed tomography (CT) scans before PPPD, as well as 7 days and 3, 6, and 12 months after surgery. Degree of pancreatic parenchymal atrophy was determined by calculating pancreatic volume relative to that on day 7. RESULTS Univariate analysis showed that patient sex, age, body mass index, concurrent pancreatitis, pathology, and types of PJ did not significantly affect changes in pancreatic volume following PPPD. The degree of pancreatic volume atrophy did not differ significantly in the external and internal drainage groups. No patient in the external drainage group experienced drainage-related surgical complications. The incidence of PJ leak was comparable in the two groups. Postoperative pancreatic atrophy did not induce new-onset diabetes mellitus at 1 year. CONCLUSIONS Both external and internal pancreatic drainage methods showed similar atrophy rate of the pancreatic parenchyma following PPPD.
Collapse
Affiliation(s)
- Daegwang Yoo
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Poongnap-Dong, Songpa-Gu, Seoul, 138-736, Korea
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
32
|
Wang Q, Jiang YJ, Li J, Yang F, Di Y, Yao L, Jin C, Fu DL. Is routine drainage necessary after pancreaticoduodenectomy? World J Gastroenterol 2014; 20:8110-8118. [PMID: 25009383 PMCID: PMC4081682 DOI: 10.3748/wjg.v20.i25.8110] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 02/13/2014] [Accepted: 03/06/2014] [Indexed: 02/06/2023] Open
Abstract
With the development of imaging technology and surgical techniques, pancreatic resections to treat pancreatic tumors, ampulla tumors, and other pancreatic diseases have increased. Pancreaticoduodenectomy, one type of pancreatic resection, is a complex surgery with the loss of pancreatic integrity and various anastomoses. Complications after pancreaticoduodenectomy such as pancreatic fistulas and anastomosis leakage are common and significantly associated with patient outcomes. Pancreatic fistula is one of the most important postoperative complications; this condition can cause intraperitoneal hemorrhage, septic shock, or even death. An effective way has not yet been found to avoid the occurrence of pancreatic fistula. In most medical centers, the frequency of pancreatic fistula has remained between 9% and 13%. The early detection and routine drainage of anastomotic fistulas, pancreatic fistulas, bleeding, or other intra-abdominal fluid collections after pancreatic resections are considered as important and effective ways to reduce postoperative complications and the mortality rate. However, many recent studies have argued that routine drainage after abdominal operations, including pancreaticoduodenectomies, does not affect the incidence of postoperative complications. Although inserting drains after pancreatic resections continues to be a routine procedure, its necessity remains controversial. This article reviews studies of the advantages and disadvantages of routine drainage after pancreaticoduodenectomy and discusses the necessity of this procedure.
Collapse
|
|
33
|
Orci LA, Oldani G, Berney T, Andres A, Mentha G, Morel P, Toso C. Systematic review and meta-analysis of fibrin sealants for patients undergoing pancreatic resection. HPB (Oxford) 2014; 16:3-11. [PMID: 23461684 PMCID: PMC3892308 DOI: 10.1111/hpb.12064] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 01/11/2013] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Post-operative pancreatic fistula (POPF) is a common complication after partial pancreatic resection, and is associated with increased rates of sepsis, mortality and costs. The role of fibrin sealants in decreasing the risk of POPF remains debatable. The aim of this study was to evaluate the literature regarding the effectiveness of fibrin sealants in pancreatic surgery. METHODS A comprehensive database search was conducted. Only randomized controlled trials comparing fibrin sealants with standard care were included. A meta-analysis regarding POPF, intra-abdominal collections, post-operative haemorrhage, pancreatitis and wound infections was performed according to the recommendations of the Cochrane collaboration. RESULTS Seven studies were included, accounting for 897 patients. Compared with controls, patients receiving fibrin sealants had a pooled odds ratio (OR) of developing a POPF of 0.83 [95% confidence interval (CI): 0.6-1.14], P = 0.245. There was a trend towards a reduction in post-operative haemorrhage (OR = 0.43 (95%CI: 0.18-1.0), P = 0.05) and intra-abdominal collections (OR = 0.52 (95%CI: 0.25-1.06), P = 0.073) in those patients receiving fibrin sealants. No difference was observed in terms of mortality, wound infections, re-interventions or hospital stay. CONCLUSION On the basis of these results, fibrin sealants cannot be recommended for routine clinical use in the setting of pancreatic resection.
Collapse
Affiliation(s)
- Lorenzo A Orci
- Division of Visceral and Transplantation Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | | | | | | | | | | | | |
Collapse
|
|
34
|
Bartoli E, Rebibo L, Robert B, Fumery M, Delcenserie R, Regimbeau JM. Efficacy of the double-pigtail stent as a conservative treatment for grade B pancreatic fistula after pancreatoduodenectomy with pancreatogastric anastomosis. Surg Endosc 2013; 28:1528-34. [PMID: 24337192 DOI: 10.1007/s00464-013-3347-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Accepted: 11/18/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Despite improvements in surgical techniques and postoperative care, morbidity associated with pancreatoduodenectomy (PD) is still high. Grade B pancreatic fistula (PF) requires a specific combination of radiologically guided external drainage and medical support. This treatment is effective but requires prolonged hospitalization and maintenance of external drainage. The objective of this study was to evaluate the feasibility and efficacy of a double-pigtail stent (DPS) to treat grade B PF after PD with pancreatogastric anastomosis. METHODS Between January 2008 and October 2011, all patients who presented grade B PF after PD (n = 6) were included in the study. The PF was diagnosed according to the criteria of the International Study Group on Pancreatic Fistula. Endoscopic treatment was standardized with a DPS. The primary efficacy end point was the feasibility and efficacy of DPS placement. Secondary end points included data on the PF, the DPS placement procedure, and long-term outcome. RESULTS Endoscopic DPS placement was achieved in all patients with no complications. The median time to onset of PF after PD was 14 days. Closure of the external PF was obtained 7 days after the introduction of the DPS. The median time to external drain removal was 7 days after DPS placement, and the median time to oral refeeding was 7 days after DPS placement for all patients. The median time to DPS removal was 60 days. The median length of hospital stay after DPS placement was 10 days. During a median follow-up period of 21 months, there was no recurrence of PF after removal of the DPS. CONCLUSION Endoscopic treatment of grade B PF after PD appears to be effective and safe and is associated with shorter hospitalization.
Collapse
Affiliation(s)
- Eric Bartoli
- Department of Gastroenterology, Amiens University Medical Center and the Jules Verne University of Picardie, Amiens, France
| | | | | | | | | | | |
Collapse
|
|
35
|
Ansorge C, Nordin JZ, Lundell L, Strömmer L, Rangelova E, Blomberg J, del Chiaro M, Segersvärd R. Diagnostic value of abdominal drainage in individual risk assessment of pancreatic fistula following pancreaticoduodenectomy. Br J Surg 2013; 101:100-8. [DOI: 10.1002/bjs.9362] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2013] [Indexed: 12/15/2022]
Abstract
Abstract
Background
The use of prophylactic abdominal drainage following pancreaticoduodenectomy (PD) is controversial as its therapeutic value is uncertain. However, the diagnosis of postoperative pancreatic fistula (POPF), the main cause of PD-associated morbidity, is often based on drain pancreatic amylase (DPA) levels. The aim of this study was to assess the predictive value of DPA, plasma pancreatic amylase (PPA) and serum C-reactive protein (CRP) for diagnosing POPF after PD.
Methods
Patients undergoing PD with prophylactic drainage between 2008 and 2012 were studied prospectively. DPA, PPA and CRP levels were obtained daily. Differences between groups with clinically relevant POPF (International Study Group on Pancreatic Fistula (ISGPF) grade B/C) and without clinically relevant POPF (no POPF or ISGPF grade A) were evaluated. Receiver operating characteristic (ROC) analyses were performed to determine the value of DPA, PPA and CRP in prediction of POPF. Risk profiles for clinically relevant POPF were constructed and related to the intraoperative pancreatic risk assessment.
Results
Fifty-nine (18·7 per cent) of 315 patients developed clinically relevant POPF. DPA, PPA and CRP levels on postoperative day (POD) 1–3 differed significantly between the study groups. In predicting POPF, the DPA level on POD 1 (cut-off at 1322 units/l; odds ratio (OR) 24·61, 95 per cent confidence interval 11·55 to 52·42) and POD 2 (cut-off at 314 units/l; OR 35·45, 14·07 to 89·33) was superior to that of PPA on POD 1 (cut-off at 177 units/l; OR 13·67, 6·46 to 28·94) and POD 2 (cut-off at 98 units/l; OR 16·97, 8·33 to 34·59). When DPA was combined with CRP (cut-off on POD 3 at 202 mg/l; OR 16·98, 8·43 to 34·21), 90·3 per cent of postoperative courses could be predicted correctly (OR 44·14, 16·89 to 115·38).
Conclusion
The combination of serum CRP and DPA adequately predicted the development of clinically relevant pancreatic fistula following PD.
Collapse
Affiliation(s)
- C Ansorge
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - J Z Nordin
- Department of Laboratory Medicine, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - L Lundell
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - L Strömmer
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - E Rangelova
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - J Blomberg
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - M del Chiaro
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - R Segersvärd
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
|
36
|
Intraperitoneal drainage after pancreatic resection: a review of the evidence. J Surg Res 2013; 184:925-30. [DOI: 10.1016/j.jss.2013.05.092] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 05/01/2013] [Accepted: 05/24/2013] [Indexed: 12/14/2022]
|
|
37
|
Martin I, Au K. Does fibrin glue sealant decrease the rate of anastomotic leak after a pancreaticoduodenectomy? Results of a prospective randomized trial. HPB (Oxford) 2013; 15:561-6. [PMID: 23458447 PMCID: PMC3731575 DOI: 10.1111/hpb.12018] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Accepted: 09/26/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the effect of topical fibrin glue applied externally to all anastomoses after a pancreaticoduodenectomy (PD) on drain lipase levels, anastomotic leaks, complication rates and length of hospital stay. METHODS A standardized non-pylorus preserving PD was performed with or without fibrin glue applied to each anastomosis. RESULTS Fifty-seven patients were randomized: 32 with and 25 without TISSEEL. There were no statistical differences in each group with respect to drain lipase levels (high 40% versus 43%, P = 0.794), complications including gastric or biliary leaks (24% versus 28%, P = 1.00), wound infection (16% versus 9%, P = 0.28) and a Clavien score of 3 or more (16% versus 25%, P = 0.757) or hospital stay (12 versus 17 days, P = 0.777). Most patients with elevated drain lipase levels had an unaltered clinical course not predictive of adverse outcomes. However, the operative finding of a soft pancreas (27 out of 57 patients) was associated with post-operative complications (P = 0.002). There were no peri-operative deaths. CONCLUSIONS Fibrin glue application to all anastomoses does not alter drain lipase levels. Drain lipase levels are not a significant surrogate marker for clinically significant anastomotic leaks or complications. Fibrin glue application did not reduce the incidence of an anastomotic leak or complications.
Collapse
Affiliation(s)
- Ian Martin
- Wesley and Princess Alexandra Hospitals, Brisbane, QLD, Australia.
| | | |
Collapse
|
|
38
|
Yamashita S, Sakabe M, Ishizawa T, Hasegawa K, Urano Y, Kokudo N. Visualization of the leakage of pancreatic juice using a chymotrypsin-activated fluorescent probe. Br J Surg 2013; 100:1220-8. [PMID: 23765524 DOI: 10.1002/bjs.9185] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2013] [Indexed: 12/25/2022]
Abstract
BACKGROUND Pancreatic fistula (PF) remains the most serious complication after digestive surgery. It is difficult to prevent because of the inability to visualize the leakage of pancreatic juice during surgery or to evaluate the protease activity of leaked fluid, which is responsible for PF formation. METHODS The fluorescence intensities of a chymotrypsin probe (glutaryl-phenylalanine [corrected] hydroxymethyl rhodamine green with added trypsin) in pancreatic juice and in intestinal or abdominal fluids drained after pancreatic resection were evaluated. The chymotrypsin probe was sprayed on to filter papers that had been placed on the resected pancreatic stump in patients undergoing pancreaticoduodenectomy or central pancreatectomy. The ability of this technique to visualize the leakage of pancreatic juice and predict postoperative PF formation was assessed. RESULTS The fluorescence intensity of the chymotrypsin probe in 76 fluid samples correlated positively with amylase levels (r(s) = 0.678, P < 0.001). The fluorescence patterns of the pancreatic stump were classified grossly into the three types: duct (fluorescence signal visualized only on the stump of the main pancreatic duct, 16 patients), diffuse (ductal stump and surrounding pancreatic parenchyma, 7) and negative (no fluorescence signal, 7). Symptomatic PFs developed in 13 of 23 patients with duct- or diffuse-type fluorescence, but in none of the seven patients with negative-type fluorescence (P = 0.008). CONCLUSION The chymotrypsin probe enabled determination of the protease activity in drained pancreatic fluid samples and allowed real-time visualization of pancreatic juice leakage during surgery.
Collapse
Affiliation(s)
- S Yamashita
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | | | | | | | | | | |
Collapse
|