Serum Creatinine and Amylase in Drain to Predict Pancreatic Fistula Risk after Pancreatoduodenectomy.

IF 1.8 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Digestive Surgery Pub Date : 2023-01-01 Epub Date: 2023-10-20 DOI:10.1159/000533869

Yunda Song, Subo Zhang

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Abstract

Introduction: The identification of patients with low risk of clinically relevant postoperative pancreatic fistula (CR-POPF) and postoperative hemorrhage (PPH) can guide drain removal after pancreatoduodenectomy (PD). However, drain fluid amylase (DFA) ≤5,000 U/L on postoperative day (POD) 1 does not robustly predict the absence of CR-POPF.

Methods: Consecutive patients undergoing PD at Sun Yat-sen University Cancer Center between July 2018 and October 2021 were analyzed. Recursive partitioning analysis was used to classify patients into groups with different risks of CR-POPF and PPH.

Results: Among 288 consecutive patients included, 99 patients (34.38%) developed CR-POPF (86 grade B and 13 grade C). Patients with CR-POPF had increased levels of preoperative creatinine (CRE) and POD1 CRE. The combination of POD1 CRE (>104 μmol/L or not) and POD1 DFA (>5,000 U/L or not) stratified patients into subgroups with the maximum difference in CR-POPF risk. The CR-POPF rates were 17.82% (36/202) in group A (POD1 CRE ≤104 μmol/L and POD1 DFA ≤5,000 U/L), 53.33% (8/15) in group B (POD1 CRE >104 μmol/L and POD1 DFA ≤5,000 U/L), and 77.46% (55/71) in group C (POD1 DFA >5,000 U/L). The PPH rates were 1.98% (4/202), 20.00% (3/15), and 19.72% (14/71) in groups A, B, and C, respectively.

Conclusion: Patients with POD1 DFA ≤5,000 U/L and POD1 CRE >104 μmol/L have a high risk of CR-POPF and may not benefit from early drain removal. Patients with POD1 DFA ≤5,000 U/L and POD1 CRE ≤104 μmol/L have low risk of CR-POPF and PPH.

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引流管中血清肌酐和淀粉酶预测胰十二指肠切除术后胰瘘风险。

引言：识别临床相关的术后胰瘘（CR-POPF）和术后出血（PPH）的低风险患者可以指导胰十二指肠切除术（PD）后的引流管移除。然而，术后第1天引流液淀粉酶（DFA）≤5000U/L（POD）并不能有力地预测CR-POPF的缺失。方法：分析2018年7月至2021年10月在中山大学癌症中心连续接受PD的患者。采用递归划分分析将患者分为不同CR-POPF和PPH风险的组。结果：在288名连续患者中，99名患者（34.38%）出现CR-POPF。CR-POPF患者术前肌酸酐（CRE）和POD1 CRE水平升高。POD1 CRE（>104μmol/L或否）和POD1 DFA（>5000 U/L或否）的组合将患者分为CR-POPF风险差异最大的亚组。CR-POPF发生率A组为17.82%（36/202）（POD1 CRE≤104μmol/L，POD1 DFA≤5000U/L），B组为53.33%（8/15）（POD1CRE>104μmol/L，且POD1DFA≤5000 U/L）。A、B和C组的PPH发生率分别为1.98%（4/202）、20.00%（3/15）和19.72%（14/71）。结论：POD1-DFA≤5000U/L和POD1-CRE>104μmol/L的患者发生CR-POPF的风险较高，可能不会从早期引流中获益。POD1 DFA≤5000 U/L和POD1 CRE≤104μmol/L的患者发生CR-POPF和PPH的风险较低。

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来源期刊

Digestive Surgery 医学-外科

CiteScore

4.90

自引率

3.70%

发文量

审稿时长

3 months

期刊介绍： ''Digestive Surgery'' presents a comprehensive overview in the field of gastrointestinal surgery. Interdisciplinary in scope, the journal keeps the specialist aware of advances in all fields that contribute to improvements in the diagnosis and treatment of gastrointestinal disease. Particular emphasis is given to articles that evaluate not only recent clinical developments, especially clinical trials and technical innovations such as new endoscopic and laparoscopic procedures, but also relevant translational research. Each contribution is carefully aligned with the need of the digestive surgeon. Thus, the journal is an important component of the continuing medical education of surgeons who want their practice to benefit from a familiarity with new knowledge in all its dimensions.