The role of clinically relevant intra-abdominal collections after pancreaticoduodenectomy
Lopez, Pablo (Universitat Autònoma de Barcelona)
Pando, Elizabeth (Universitat Autònoma de Barcelona. Departament de Cirurgia)
Ortega-Torrecilla, Nuria (Hospital Universitari Vall d'Hebron)
Puertolas, Noelia (Hospital Universitari Vall d'Hebron)
Adell-Trapé, Montse (Hospital Universitari Vall d'Hebron)
Fernandes, Nair (Hospital Universitari Vall d'Hebron)
Herms, Daniel (Hospital Universitari Vall d'Hebron)
Barros, Marta (Hospital Universitari Vall d'Hebron)
Blanco Cuso, Laia (Hospital Universitari Vall d'Hebron)
Balsells Valls, Joaquim (Hospital Universitari Vall d'Hebron)
Charco, Ramon (Hospital Universitari Vall d'Hebron)

Data:	2023
Resum:	There is controversial evidence regarding the impact of clinically relevant postoperative intra-abdominal collections (CR-IC) on the clinical course after pancreaticoduodenectomy. C-reactive Protein (CRP) has been validated as a predictor of postoperative pancreatic fistula (POPF). Still, its role in predicting CR-IC has not been studied. A retrospective analysis was conducted on patients who underwent PD at a tertiary hospital between October 2012 and October 2017. The incidence of CR-IC, clinically relevant POPF and other complications, as well as mortality and length of hospitalisation, was retrieved. The impact of CR-IR on mortality and major complications was analysed. The serum CRP levels were retrieved on the third and fifth postoperative days (POD3 and POD5), followed by an analysis of sensitivity, specificity, and area under the curve to predict CR-IC using CRP. One hundred forty patients were enrolled following inclusion and exclusion criteria. The mean age was 66. 5 years (15-83). The incidence of CR-IC was 33. 7% (47), and CR-POPF was 24. 3%. Pancreatic duct diameter ≤ 4 mm was identified as a risk factor related to CR-IC occurrence. The group of patients who developed CR-IC after PD exhibited a higher rate of complications Clavien-Dindo ≥ III compared to patients without CR-IC (40. 4% vs 7. 5%, p < 0. 001), as well as other events such as admission to the intensive care unit (25. 5% vs 4. 3%, p < 0. 001), the incidence of CR-POPF (66% vs 3. 2%, p < 0. 001), prolonged hospital stay (32 vs 13 days, p < 0. 001), postoperative haemorrhage (23. 4 vs 5. 4%, p = 0. 002), and delayed gastric empty (38. 8% vs 11. 8%, p < 0. 001) respectively. Logistic regression analysis identified CR-IC related to POPF as a risk factor for Clavien-Dindo > III: OR = 10. 6 (95% CI: 3. 90-28. 7). No differences in mortality were reported between the CR-IC group and non-CR-IC group. CRP at postoperative day 3 (POD3) > 17. 55 mg/dl and CRP at postoperative day 5 (POD5) > 13. 46 mg/dl were predictors of CR-IC (AUC: 0. 731 and AUC:0. 821, respectively). CR-IC has a significant impact after pancreaticoduodenectomy and is associated with a higher incidence of Clavien-Dindo ≥ III complications. Additionally, CRP levels at POD3 and POD5 play a role in predicting CR-IC. Prospective studies are essential to explore strategies for mitigating the occurrence of CR-IC after PD. The online version contains supplementary material available at 10. 1007/s00423-023-03200-z.
Nota:	Altres ajuts: acords transformatius de la UAB
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Postoperative collections ; Pancreatectomy complications ; Pancreatic fistula ; Surgical complications
Publicat a:	Langenbeck's archives of surgery, Vol. 409 (december 2023) , ISSN 1435-2451

Adreça original: https://link.springer.com/article/10.1007/s00423-023-03200-z
DOI: 10.1007/s00423-023-03200-z
PMID: 38151676

10 p, 808.5 KB

El registre apareix a les col·leccions:
Articles > Articles de recerca
Articles > Articles publicats