Coppola Alessandro, La Vaccara Vincenzo, Angeletti Silvia, Spoto Silvia, Farolfi Tommaso, Cammarata Roberto, Maltese Girolamo, Coppola Roberto, Caputo Damiano
Dipartimento di Chirurgia, Sapienza Università di Roma, Rome, Italy.
General Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.
J Gastrointest Oncol. 2023 Apr 29;14(2):1077-1086. doi: 10.21037/jgo-22-803. Epub 2023 Feb 7.
Early detection and therapy of pancreatic fistula after pancreaticoduodenectomy is crucial to improve outcomes of this surgery. Since it is not clear if procalcitonin (PCT), can predict the onset of clinically relevant post-operative pancreatic fistula (CR-POPF), we aimed to investigate this ability.
One-hundred-thirty pancreaticoduodenectomies (PD) were analyzed. Receiver Operating Characteristic curves analysis defined the optimal cut-offs for PCT and drains amylase levels (DAL). Complications were compared using chi-square for proportions test.
DAL ≥2,000 U/L in postoperative day (POD) 2 had 71% positive predictive value (PPV) and 91% negative predictive value (NPV) for CR-POPF (P<0.001). In POD2, PCT ≥0.5 ng/mL showed NPV 91% (P<0.045) and increased DAL PPV for CR-POPF to 81%. In POD3, POD4 and POD5, DAL (cut-offs 780, 157 and 330 U/L, respectively) showed NPV for CR-POPF >90% (P<0.0001). PCT ≥0.5 ng/mL showed NPV for CR-POPF of about 90%. In POD5, combining DAL (cut-off 330 U/L) and PCT (cut-off 0.5 ng/mL), a PPV for CR-POPF of 81% was detected. A progressive increased risk of CR-POPF from POD2 [odds ratio (OR) =3.05; P=0.0348] to POD5 (OR =4.589; P=0.0082) was observed. In POD2 and 5, PCT ≥0.5 ng/mL, alone and in combination with DAL, may be a reliable marker for identifying patients at highest risk of CR-POPF after PD.
This association could be proposed to select high risk patients that could benefit of "intensive" postoperative management.
胰十二指肠切除术后胰瘘的早期发现和治疗对于改善该手术的预后至关重要。由于目前尚不清楚降钙素原（PCT）能否预测临床相关的术后胰瘘（CR-POPF）的发生，我们旨在研究其预测能力。
分析了130例胰十二指肠切除术（PD）。通过受试者工作特征曲线分析确定了PCT和引流液淀粉酶水平（DAL）的最佳临界值。使用卡方检验比较并发症的比例。
术后第2天（POD）DAL≥2000 U/L对CR-POPF的阳性预测值（PPV）为71%，阴性预测值（NPV）为91%（P<0.001）。在POD2时，PCT≥0.5 ng/mL的NPV为91%（P<0.045），且使CR-POPF的DAL PPV提高到81%。在POD3、POD4和POD5时，DAL（临界值分别为780、157和330 U/L）对CR-POPF的NPV>90%（P<0.0001）。PCT≥0.5 ng/mL对CR-POPF的NPV约为90%。在POD5时，联合DAL（临界值330 U/L）和PCT（临界值0.5 ng/mL），检测到CR-POPF的PPV为81%。观察到从POD2到POD5，CR-POPF的风险逐渐增加[比值比（OR）=3.05；P=0.0348]至POD5（OR =4.589；P=0.0082）。在POD2和5时，PCT≥0.5 ng/mL单独或与DAL联合，可能是识别PD术后CR-POPF高危患者的可靠标志物。
可以提出这种关联以选择可能从“强化”术后管理中获益的高危患者。
