Year 2023 / Volume 115 / Number 7
Original
C-reactive protein postoperative values to predict clinically relevant postoperative pancreatic fistula after distal pancreatectomy

362-367

DOI: 10.17235/reed.2022.8795/2022

Luz Divina Juez, Elena Payno, Irene de Vicente, Eduardo Lisa, José Manuel Molina, Eduardo Lobo Martínez, José María Fernández Cebrián, Alfonso Sanjuanbenito,

Abstract
Introduction: despite significant medical and technological advances, the incidence of postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP) is reported to be between 3-45 %. The main objective of this study was to analyze the early post-surgical risk factors for developing POPF after DP. Material and methods: a retrospective observational study was performed on a prospective basis of patients undergoing DP in a tertiary hospital from January 2011 to December 2021. Sociodemographic, preoperative analytical, tumor-related and postoperative complications variables were analyzed. Results: of the 52 patients analyzed, 71.8 % of the sample had postoperative drains amylase elevation. However, 25.7 % of the total had grade-B and/or grade-C POPF. Univariate logistic regression with the variables studied showed the following as risk factors for B-C or clinically relevant POPF: amylase values in drainage at the 5th postoperative day (POD) (p = 0.097; 1.01 [1-1.01]), preoperative BMI (p = 0.015; 1.27 [1.04-1.55]) and C-reactive protein (CRP) value at the 3rd POD (p = 0.034; 1.01 [1.01-1.02]). The ROC curve of CRP value at the 3rd POD showed an area under the curve of 0.764 (95 % CI: 0.6-0.93) and the best cut-off point was 190 mg/l (sensitivity 89 % and specificity 67 %). Conclusions: CRP value at the 3rd POD is a predictive factor for POPF after DP. Early detection of patients at risk of POPF based on these characteristics could have an impact on their postoperative management.
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References
1. Ecker BL, McMillan MT, Allegrini V, Bassi C, Beane JD, Beckman RM, et al. Risk Factors and Mitigation Strategies for Pancreatic Fistula After Distal Pancreatectomy: Analysis of 2026 Resections From the International, Multi-institutional Distal Pancreatectomy Study Group. Ann Surg [Internet]. 2019;269(1). Available from: https://journals.lww.com/annalsofsurgery/Fulltext/2019/01000/Risk_Factors_and_Mitigation_Strategies_for.28.aspx
2. Beane JD, Pitt HA, Dolejs SC, Hogg ME, Zeh HJ, Zureikat AH. Assessing the impact of conversion on outcomes of minimally invasive distal pancreatectomy and pancreatoduodenectomy. HPB [Internet]. 2018;20(4):356–63. Available from: https://www.sciencedirect.com/science/article/pii/S1365182X17311061
3. Bassi C, Marchegiani G, Dervenis C, Sarr M. Pancreas The 2016 update of the International Study Group ( ISGPS ) definition and grading of postoperative pancreatic fistula : 11 Years After. Surgery [Internet]. 2016;161(3):584–91. Available from: http://dx.doi.org/10.1016/j.surg.2016.11.014
4. Allen PJ, Gönen M, Brennan MF, Bucknor AA, Robinson LM, Pappas MM, et al. Pasireotide for Postoperative Pancreatic Fistula. N Engl J Med [Internet]. 2014 May 21;370(21):2014–22. Available from: https://doi.org/10.1056/NEJMoa1313688
5. Diener MK, Knaebel HP, Witte ST, Rossion I, Kieser M, Buchler MW, et al. DISPACT trial: a randomized controlled trial to compare two different surgical techniques of DIStal PAnCreaTectomy - study rationale and design. Clin Trials. 2008;5(5):534–45.
6. Chong E, Ratnayake B, Lee S, French JJ, Wilson C, Roberts KJ, et al. Systematic review and meta-analysis of risk factors of postoperative pancreatic fi stula after distal pancreatectomy in the era of 2016 International Study Group pancreatic fi stula de fi nition. Int Hepato-Pancreato-Biliary Assoc [Internet]. 2021;23(8):1139–51. Available from: https://doi.org/10.1016/j.hpb.2021.02.015
7. Kawaida H, Kono H, Hosomura N, Amemiya H, Itakura J, Fujii H, et al. Surgical techniques and postoperative management to prevent postoperative pancreatic fistula after pancreatic surgery. 2019;25(28):3722–37.
8. Probst P, Schuh F, Dörr-Harim C, Sander A, Bruckner T, Klose C, et al. Protocol for a randomised controlled trial to compare postoperative complications between minimally invasive and open DIStal PAnCreaTectomy (DISPACT-2 trial). BMJ Open. 2021 Feb;11(2):e047867.
9. Yang F, Jin C, Hao S, Fu D. Drain Contamination after Distal Pancreatectomy: Incidence, Risk Factors, and Association with Postoperative Pancreatic Fistula. J Gastrointest Surg. 2019;23(12):2449–58.
10. Villafane-Ferriol N, Van Buren G, Mendez-Reyes JE, McElhany AL, Massarweh NN, Silberfein EJ, et al. Sequential drain amylase to guide drain removal following pancreatectomy. Hpb. 2018;20(6):514–20.
11. Uchida Y, Masui T, Nakano K, Yogo A, Yoh T, Nagai K, et al. Combination of postoperative C-reactive protein value and computed tomography imaging can predict severe pancreatic fistula after pancreatoduodenectomy. Hpb [Internet]. 2020;22(2):282–8. Available from: https://doi.org/10.1016/j.hpb.2019.06.020
12. Malya FU, Hasbahceci M, Tasci Y, Kadioglu H, Guzel M, Karatepe O, et al. The Role of C-Reactive Protein in the Early Prediction of Serious Pancreatic Fistula Development after Pancreaticoduodenectomy. Gastroenterol Res Pract [Internet]. 2018 Jan 28;2018:9157806. Available from: https://pubmed.ncbi.nlm.nih.gov/29619047
13. SAKAMOTO T, YAGYU Y, UCHINAKA EI, MORIMOTO M, HANAKI T, TOKUYASU N, et al. Predictive Significance of C-reactive Protein-to-albumin Ratio for Postoperative Pancreatic Fistula After Pancreaticoduodenectomy. Anticancer Res [Internet]. 2019 Nov 1;39(11):6283 LP – 6290. Available from: http://ar.iiarjournals.org/content/39/11/6283.abstract
14. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.
15. Bonaroti JW, Zenati MS, Al-abbas AI, Rieser CJ, Zureikat AH, Hogg ME, et al. Impact of postoperative pancreatic fistula on long-term oncologic outcomes after pancreatic resection. Hpb [Internet]. 2021;23(8):1269–76. Available from: https://doi.org/10.1016/j.hpb.2020.12.010
16. Watanabe N, Yamamoto Y, Sugiura T, Okamura Y, Ito T, Ashida R, et al. The Impact of Stump Closure Techniques on Pancreatic Fistula Stratified by the Thickness of the Pancreas in Distal Pancreatectomy. Dig Surg. 2020;37(4):340–7.
17. Singh PP, Zeng ISL, Srinivasa S, Lemanu DP, Connolly AB, Hill AG. Systematic review and meta-analysis of use of serum C-reactive protein levels to predict anastomotic leak after colorectal surgery. Br J Surg. 2014;101(4):339–46.
18. Warschkow R, Beutner U, Steffen T, Müller SA, Schmied BM, Güller U, et al. Safe and early discharge after colorectal surgery due to C-reactive protein: A diagnostic meta-analysis of 1832 patients. Ann Surg. 2012;256(2):245–50.
19. Partelli S, Pecorelli N, Muffatti F, Belfiori G, Crippa S, Piazzai F, et al. Early Postoperative Prediction of Clinically Relevant Pancreatic Fistula after Pancreaticoduodenectomy: usefulness of C-reactive Protein. Hpb. 2017;19(7):580–6.
20. van Dongen JC, Smits FJ, van Santvoort HC, Molenaar IQ, Busch OR, Besselink MG, et al. C-reactive protein is superior to white blood cell count for early detection of complications after pancreatoduodenectomy: a retrospective multicenter cohort study. Hpb [Internet]. 2020;22(10):1504–12. Available from: https://doi.org/10.1016/j.hpb.2020.02.005
21. Sakamoto K, Ogawa K, Tamura K, Iwata M, Matsui T, Nishi Y, et al. Postoperative elevation of C-reactive protein levels and high drain fluid amylase output are strong predictors of pancreatic fistulas after distal pancreatectomy. J Hepatobiliary Pancreat Sci. 2021;28(10):874–82.
22. He S, Xia J, Zhang W, Lai M, Cheng N, Liu Z, et al. Prophylactic abdominal drainage for pancreatic surgery. Cochrane database Syst Rev. 2021 Dec;12(12):CD010583.
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Juez L, Payno E, de Vicente I, Lisa E, Molina J, Lobo Martínez E, et all. C-reactive protein postoperative values to predict clinically relevant postoperative pancreatic fistula after distal pancreatectomy. 8795/2022


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Publication history

Received: 16/03/2022

Accepted: 20/06/2022

Online First: 24/06/2022

Published: 06/07/2023

Article revision time: 91 days

Article Online First time: 100 days

Article editing time: 477 days


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