1
|
Perri G, Romandini E, Marchegiani G, Ghorbani P, Sahakyan M, Holmberg M, Cattelani A, Fretland Å, Montorsi R, Rodrigues ID, Kleive D, Bannone E, Edwin B, Gilg S, Labori K, Sparrelid E, Salvia R. Postoperative Hyperamylasemia (POH) is an Early Predictor of Pancreatic Fistula Occurrence and Severity after Distal Pancreatectomy: Results from a European Multicentric Study. Ann Surg 2024:00000658-990000000-00766. [PMID: 38305035 DOI: 10.1097/sla.0000000000006222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
OBJECTIVES The aim of this international multicentric study is to characterize postoperative hyperamylasemia (POH) after distal pancreatectomy (DP), with particular focus on its relationship with postoperative pancreatic fistula (POPF) occurrence and severity. BACKGROUND The clinical relevance of POH after DP and its relationship with the occurrence and severity of POPF have not been explored yet. METHODS All patients undergoing DP for any indication between 2015 and 2021 at three European referral Centers for pancreatic surgery were retrospectively analyzed. Drain fluid amylase (DFA), C-reactive protein (C-RP), and serum amylase were examined from postoperative-day (POD) 1 to 3. Biochemical leak (BL), POPF, POH, and post-pancreatectomy hemorrhage (PPH) were defined and graded according to ISGPS definitions. RESULTS In total 1192 patients were included. Overall rates of POH and POPF were 18% (n= 210) and 29% (n= 344), respectively. The presence of DFA ≥2000 U/L on POD 1 (OR=2.11, 95% CI 1.68-2.86), C-RP ≥200 mg/L on POD 3 (OR=2.19, 95% CI 1.68-2.86), and POH (OR=1.58, 95% CI 1.14-2.19) were all independent early predictors of POPF (all P< 0.01). The presence of POH almost doubled the rate of POPF (43% vs. 26%, P<0.001), and higher POPF severity presented also higher POH rates (no POPF= 12%; BL= 19%; B POPF= 24%; C POPF= 52%). Among patients developing POPF, patients with POH had higher rates of PPH (22% vs 9%, P= 0.001), sepsis (24% vs 13%; P=0.011), re-operation (21% vs 8%; P< 0.01), and mortality (3% vs 0.3%; P= 0.025). CONCLUSIONS The occurrence of POH is an early predictor of POPF and its severity after DP. The diagnosis of POH might define patients at higher risk for a complicated course, targeting them for prevention / mitigation strategies against pancreas specific complications.
Collapse
Affiliation(s)
- Giampaolo Perri
- Verona University Hospital, Department of General and Pancreatic Surgery (Verona, Italy)
- Karolinska University Hospital, Division of Surgery, Department of Clinical Science, Intervention and Technology (Stockholm, Sweden)
| | - Elisa Romandini
- Verona University Hospital, Department of General and Pancreatic Surgery (Verona, Italy)
- Oslo University Hospital, Department of Hepato-pancreato-biliary Surgery (Oslo, Norway)
| | - Giovanni Marchegiani
- Verona University Hospital, Department of General and Pancreatic Surgery (Verona, Italy)
- University of Padua, Department of Surgery, Oncology and Gastroenterology (DiSCOG), Hepato-pancreato-biliary and Liver Transplant Surgery (Padua, Italy)
| | - Poya Ghorbani
- Karolinska University Hospital, Division of Surgery, Department of Clinical Science, Intervention and Technology (Stockholm, Sweden)
| | - Musheg Sahakyan
- Oslo University Hospital, Department of Hepato-pancreato-biliary Surgery (Oslo, Norway)
| | - Marcus Holmberg
- Karolinska University Hospital, Division of Surgery, Department of Clinical Science, Intervention and Technology (Stockholm, Sweden)
- St Görans Hospital, Emergency, Upper GI, Bariatric and Abdominal wall surgery (Stockholm, Sweden)
| | - Alice Cattelani
- Verona University Hospital, Department of General and Pancreatic Surgery (Verona, Italy)
| | - Åsmund Fretland
- Oslo University Hospital, Department of Hepato-pancreato-biliary Surgery (Oslo, Norway)
| | - Roberto Montorsi
- Verona University Hospital, Department of General and Pancreatic Surgery (Verona, Italy)
| | - Isabella D Rodrigues
- Verona University Hospital, Department of General and Pancreatic Surgery (Verona, Italy)
| | - Dyre Kleive
- Oslo University Hospital, Department of Hepato-pancreato-biliary Surgery (Oslo, Norway)
| | - Elisa Bannone
- Verona University Hospital, Department of General and Pancreatic Surgery (Verona, Italy)
| | - Bjørn Edwin
- Oslo University Hospital, Department of Hepato-pancreato-biliary Surgery (Oslo, Norway)
| | - Stefan Gilg
- Karolinska University Hospital, Division of Surgery, Department of Clinical Science, Intervention and Technology (Stockholm, Sweden)
| | - Knut Labori
- Oslo University Hospital, Department of Hepato-pancreato-biliary Surgery (Oslo, Norway)
| | - Ernesto Sparrelid
- Karolinska University Hospital, Division of Surgery, Department of Clinical Science, Intervention and Technology (Stockholm, Sweden)
| | - Roberto Salvia
- Verona University Hospital, Department of General and Pancreatic Surgery (Verona, Italy)
| |
Collapse
|