Postoperative hyperamylasemia (POH) and acute pancreatitis after pancreatoduodenectomy (POAP): State of the art and systematic review.

Published on Feb 1, 2021in Surgery3.356
· DOI :10.1016/J.SURG.2020.04.062
Elisa Bannone3
Estimated H-index: 3
(University of Verona),
Stefano Andrianello16
Estimated H-index: 16
(University of Verona)
+ 4 AuthorsClaudio Bassi110
Estimated H-index: 110
(University of Verona)
Sources
Abstract
Abstract Background Postoperative hyperamylasemia is a frequent finding after pancreatoduodenectomy, but its incidence and clinical implications have not yet been analyzed systematically. The aim of this review is to reappraise the concept of postoperative hyperamylasemia with postoperative acute pancreatitis, including its definition, interpretation, and correlation. Methods Online databases were used to search all available relevant literature published through June 2019. The following search terms were used: “pancreaticoduodenectomy,” “amylase,” and “pancreatitis.” Surgical series reporting data on postoperative hyperamylasemia or postoperative acute pancreatitis were selected and screened. Results Among 379 screened studies, 39 papers were included and comprised data from a total of 9,220 patients. Postoperative hyperamylasemia was rarely defined in most of these series, and serum amylase values were measured at different cutoff levels and reported on different postoperative days. The actual levels of serum amylase activity and the representative cutoff levels required to reach a diagnosis of postoperative acute pancreatitis were markedly greater on the first postoperative days and tended to decrease over time. Most studies analyzing postoperative hyperamylasemia focused on its correlation with postoperative pancreatic fistula and other postoperative morbidities. The incidence of postoperative acute pancreatitis varied markedly between studies, with its definition completely lacking in 40% of the analyzed papers. A soft pancreatic parenchyma, a small pancreatic duct, and pathology differing from cancer or chronic pancreatitis were all predisposing factors to the development of postoperative hyperamylasemia. Conclusion Postoperative hyperamylasemia has been proposed as the biochemical expression of pancreatic parenchymal injury related to localized ischemia and inflammation of the pancreatic stump. Such phenomena, analogous to those associated with acute pancreatitis, could perhaps be renamed as postoperative acute pancreatitis from a clinical standpoint. Patients with postoperative acute pancreatitis experienced an increased rate of all postoperative complications, particularly postoperative pancreatic fistula. Taken together, the discrepancies among previous studies of postoperative hyperamylasemia and postoperative acute pancreatitis outlined in the present review may provide a basis for stronger evidence necessary for the development of universally accepted definitions for postoperative hyperamylasemia and postoperative acute pancreatitis.
References50
Newest
#1Brigitta Globke (Humboldt University of Berlin)H-Index: 5
#1Brigitta Globke (Humboldt University of Berlin)H-Index: 1
Last. Thomas Malinka (Humboldt University of Berlin)H-Index: 1
view all 7 authors...
Abstract Background Recent studies have suggested acute pancreatitis as a separate pancreatic-specific complication following pancreaticoduodenectomy. However, data on necrotizing pancreatitis of the pancreatic remnant is limited. This study aimed to evaluate parameters of patients undergoing completion pancreatectomy (CP) after initial pancreaticoduodenectomy (PD) and compare those with or without necrosis of the pancreatic remanent. Methods Patients who underwent CP following PD between Januar...
5 CitationsSource
#1Emrullah Birgin (Heidelberg University)H-Index: 8
#2Alina Reeg (Heidelberg University)H-Index: 1
Last. Felix Rückert (Heidelberg University)H-Index: 21
view all 7 authors...
Abstract Background/objectives Postoperative pancreatitis (POP) has recently been shown to be the cause of pancreatic fistula (POPF) following pancreaticoduodenectomy (PD). The aim of the present study was to document the perioperative outcome associated with POP and determine potential risk factors for POP. Methods Patients undergoing PD between 2009 and 2015 were identified from the prospective data base at a single center. The previous suggested definition of POP by Connor was used. Complicat...
14 CitationsSource
#1Elisa Bannone (University of Verona)H-Index: 3
#2Stefano AndrianelloH-Index: 16
Last. Roberto SalviaH-Index: 52
view all 7 authors...
Objective:The aim of the study is to characterize postoperative acute pancreatitis (POAP).Summary Background Data:A standardized definition of POAP after pancreaticoduodenectomy (PD) has been recently proposed, but specific studies are lacking.Methods:The patients were extracted from the prospective
44 CitationsSource
#1Crystal B. Chen (Thomas Jefferson University)H-Index: 2
#2Neal S. McCall (Thomas Jefferson University)H-Index: 6
Last. Harish Lavu (Thomas Jefferson University)H-Index: 19
view all 8 authors...
: Postoperative pancreatic fistula (PF) remains one of the most significant complications after pancreaticoduodenectomy (PD). Recently, studies have suggested that post-PD serum hyperamylasemia (HA) may be a risk factor. In this study, we evaluate the relationship of pancreas texture and post-operative serum amylase levels in determining PF risk. This retrospective cohort study evaluated all patients who underwent PD at Thomas Jefferson University from 2009 to 2014. The highest postoperative ser...
8 CitationsSource
#1Christopher B. Nahm (USYD: University of Sydney)H-Index: 9
#2Kai M. Brown (USYD: University of Sydney)H-Index: 4
Last. Anubhav Mittal (USYD: University of Sydney)H-Index: 23
view all 9 authors...
Abstract Background There has been recent evidence supporting post-pancreatectomy pancreatitis as a factor in the development of postoperative pancreatic fistula (POPF). The aims of this study were to evaluate: (i) the correlation of the acinar cell density at the pancreatic resection margin with the intra-operative amylase concentration (IOAC) of peri-pancreatic fluid, postoperative pancreatitis, and POPF; and (ii) the association between postoperative pancreatitis on the first postoperative da...
19 CitationsSource
#1Takehiko Hanaki (Tottori University)H-Index: 7
#2Chihiro Uejima (Tottori University)H-Index: 6
Last. Yoshiyuki Fujiwara (Tottori University)H-Index: 63
view all 10 authors...
Purpose Pancreatic fistula (PF) is the most serious complication following pancreaticoduodenectomy (PD). This study was performed to identify new clinical factors that may predict the development of PF after PD to improve perioperative management.
7 CitationsSource
#1Shuo Jin (THU: Tsinghua University)H-Index: 2
#2Xiao-Ju Shi (JLU: Jilin University)H-Index: 7
Last. Guangyi Wang (JLU: Jilin University)H-Index: 16
view all 7 authors...
Drainage fluid and serum amylase levels accurately predict development of postoperative pancreatic fistula
12 CitationsSource
#1Stefano PartelliH-Index: 43
#2Nicolò PecorelliH-Index: 20
Last. Massimo FalconiH-Index: 105
view all 10 authors...
Abstract Background An early recognition of clinically relevant pancreatic fistula (PF) after pancreaticoduodenectomy (PD) is essential. Methods All consecutive patients who underwent PD in two institutions were included (2013–2015). In all patients amylase value in drains (AVD) was evaluated in postoperative day 1 (POD1). White-blood cell count (WBC), serum pancreatic amylase (SPA) and C-reactive protein (CRP) were routinely evaluated in POD1, POD2, and POD3. Receiver operator characteristic (R...
28 CitationsSource
#1Claudio BassiH-Index: 110
Last. M.W. Büchler (Heidelberg University)H-Index: 79
view all 33 authors...
Background In 2005, the International Study Group of Pancreatic Fistula developed a definition and grading of postoperative pancreatic fistula that has been accepted universally. Eleven years later, because postoperative pancreatic fistula remains one of the most relevant and harmful complications of pancreatic operation, the International Study Group of Pancreatic Fistula classification has become the gold standard in defining postoperative pancreatic fistula in clinical practice. The aim of th...
1,280 CitationsSource
#1Christian M. Kühlbrey (University of Freiburg)H-Index: 3
#2N. Samiei (University of Freiburg)H-Index: 1
Last. Uwe A. Wittel (University of Freiburg)H-Index: 18
view all 6 authors...
Background Morbidity after pancreas resection is still high with postoperative pancreatic fistulas (POPF) being the most frequent complication. However, exocrine insufficiency seems to protect from POPF. In clinical practice, patients showing increased postoperative systemic amylase concentrations appear to frequently develop POPF. We therefore retrospectively examined the occurrence of systemic amylase increase after pancreas resections and its association with the clinical course.
23 CitationsSource
Cited By4
Newest
#1Sean P. McGuire (IU: Indiana University)H-Index: 1
#2Thomas K. Maatman (IU: Indiana University)H-Index: 7
Last. Nicholas J. Zyromski (IU: Indiana University)H-Index: 35
view all 0 authors...
Abstract null null Background null The clinical significance of postoperative serum pancreatic enzyme elevation after pancreatoduodenectomy is understudied. We hypothesized that elevation in serum enzymes predicts morbidity and mortality after pancreatoduodenectomy. null null null Methods null Retrospective review of 677 patients who underwent pancreatoduodenectomy at a single institution from 2013 to 2019. Patients were categorized based on serum enzyme concentrations. Patient characteristics, ...
Source
#1Alexandre DoussotH-Index: 16
Last. Bruno HeydH-Index: 22
view all 7 authors...
Abstract Background Postoperative acute pancreatitis (POAP) emerges as a distinct pancreas-specific complication increasing both the risk and the burden of POPF after pancreatoduodenectomy. Among various risk factors, pancreas stump (PS) hypoperfusion might play a role in POAP occurrence but has never been investigated. The current study aimed at evaluating the feasibility of intraoperative fluorescence angiography (IOFA) of the PS using ICG and its association with POAP. Methods Consecutive pat...
Source
#1Stefano Partelli (UniSR: Vita-Salute San Raffaele University)H-Index: 43
#2Valentina Andreasi (UniSR: Vita-Salute San Raffaele University)H-Index: 8
Last. Massimo Falconi (UniSR: Vita-Salute San Raffaele University)H-Index: 105
view all 12 authors...
Abstract Background A fatty infiltration of the pancreas has been traditionally regarded as the main histological risk factor for postoperative pancreatic fistula, whereas the role of the secreting acinar compartment has been poorly investigated. The aim of this study was to evaluate the role of acinar content at pancreatic resection margin in the development of clinically relevant postoperative pancreatic fistula and clinically relevant postoperative acute pancreatitis after pancreaticoduodenec...
1 CitationsSource
#1Fabio Casciani (UPenn: University of Pennsylvania)H-Index: 2
#2Claudio Bassi (University of Verona)H-Index: 110
Last. Charles M. Vollmer (UPenn: University of Pennsylvania)H-Index: 67
view all 3 authors...
Abstract Background Despite abundant, high-level scientific evidence, there is no consensus regarding the prevention, mitigation, and management of clinically relevant pancreatic fistula after pancreatoduodenectomy. The aim of the present investigation is three-fold: (1) to analyze the multiple decision-making points for pancreatico-enteric anastomotic creation and fistula mitigation and management after pancreatoduodenectomy, (2) to reveal the practice of contemporary experts, and (3) to indica...
3 CitationsSource
#1Martin Loos (University Hospital Heidelberg)H-Index: 2
#2Oliver Strobel (University Hospital Heidelberg)H-Index: 50
Last. M.W. Büchler (University Hospital Heidelberg)H-Index: 79
view all 20 authors...
Abstract Background The clinical relevance of hyperamylasemia after distal pancreatectomy (DP) remains unclear and no internationally accepted definition of postoperative acute pancreatitis (POAP) exists. The aim of this study was to characterize POAP after DP and to assess the role of serum amylase (SA) in POAP. Methods Outcomes of 641 patients who had undergone DP between 2015 and 2019 were analyzed. Postoperative SA was determined in all patients. POAP was defined based on contrast-enhanced c...
Source