Department of General Surgery, Ruijin Hospital Affiliated to Shanghai Jiaotong University, School of Medicine, China.
Department of General Surgery, Ruijin Hospital Affiliated to Shanghai Jiaotong University, School of Medicine, China.
Pancreatology. 2020 Mar;20(2):211-216. doi: 10.1016/j.pan.2019.11.014. Epub 2019 Nov 27.
Postoperative acute pancreatitis (POAP) after pancreaticoduodenectomy (PD) has been recently recognized as an independent complication that is associated with undesirable postoperative outcomes and often precedes other complications, yet predictive factors attributable to POAP after PD remain elusive.
The data from 1465 consecutive patients who underwent laparotomy or minimally invasive robotic PD from March 2010 to December 2018 were retrospectively reviewed. POAP was defined as an elevation of the serum amylase levels above the institution's normal upper limit (100 U/L) on postoperative day (POD) 1. Univariate and multivariate analyses were performed to investigate the predictive factors for POAP after PD and the association between POAP and clinically relevant postoperative pancreatic fistulas (CR-POPFs).
Among the 1465 patients, 411 (28%) underwent minimally invasive robotic surgeries, and the overall POAP and CR-POPFs rates were 770 (53%) and 277 (19%), respectively. The female sex (OR 1.76), a normal bilirubin level (OR 1.55), the robotic surgery (OR 1.36), a main pancreatic duct (MPD) ≤3 mm (OR 5.69) and a high-risk nonadenocarcinoma pathology (cystic disease: OR 4.33; pNETs: OR 4.34; others: OR 2.74) were considered independent risk factors for POAP. A nondilated MPD was a predominant predictor for POAP, with 72.2% sensitivity and 71.8% specificity. POAP was also an independent predictive factor for CR-POPFs (OR 3.48).
A nondilated MPD, a high-risk pathology, the female sex, a normal bilirubin level and the robotic surgery were independent predictive factors for POAP after PD. Prevention and early treatment strategy changes can be made based on these preoperative predictive factors.
胰十二指肠切除术（PD）后急性胰腺炎（POAP）最近被认为是一种独立的并发症，与不良的术后结果相关，并且常常先于其他并发症发生，但导致 PD 后 POAP 的预测因素仍难以捉摸。
回顾性分析了 2010 年 3 月至 2018 年 12 月期间接受剖腹手术或微创机器人 PD 的 1465 例连续患者的数据。POAP 定义为术后第 1 天（POD）血清淀粉酶水平高于机构正常上限（100 U/L）。进行单因素和多因素分析，以研究 PD 后 POAP 的预测因素以及 POAP 与临床相关的胰瘘（CR-POPFs）之间的关系。
在 1465 例患者中，411 例（28%）接受了微创机器人手术，总体 POAP 和 CR-POPFs 发生率分别为 770 例（53%）和 277 例（19%）。女性（OR 1.76）、正常胆红素水平（OR 1.55）、机器人手术（OR 1.36）、主胰管（MPD）≤3mm（OR 5.69）和高危非腺癌病理（囊性疾病：OR 4.33；pNETs：OR 4.34；其他：OR 2.74）被认为是 POAP 的独立危险因素。未扩张的 MPD 是 POAP 的主要预测因素，其敏感性为 72.2%，特异性为 71.8%。POAP 也是 CR-POPFs 的独立预测因素（OR 3.48）。
未扩张的 MPD、高危病理、女性、正常胆红素水平和机器人手术是 PD 后 POAP 的独立预测因素。可以根据这些术前预测因素制定预防和早期治疗策略的改变。
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