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04.01.2018 | Original Article

C-Reactive Protein on Postoperative Day 1 Is a Reliable Predictor of Pancreas-Specific Complications After Pancreaticoduodenectomy

verfasst von: Théophile Guilbaud, David Jérémie Birnbaum, Coralie Lemoine, Mircea Chirica, Olivier Risse, Stéphane Berdah, Edouard Girard, Vincent Moutardier

Erschienen in: Journal of Gastrointestinal Surgery | Ausgabe 5/2018

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Abstract

Background

Postoperative pancreatic fistula and pancreas-specific complications have a significant influence on patient management and outcomes after pancreatoduodenectomy. The aim of the study was to assess the value of serum C-reactive protein on the postoperative day 1 as early predictor of pancreatic fistula and pancreas-specific complications.

Methods

Between 2013 and 2016, 110 patients underwent pancreaticoduodenectomy. Clinical, biological, intraoperative, and pathological characteristics were prospectively recorded. Pancreatic fistula was graded according to the International Study Group on Pancreatic Fistula classification. A composite endpoint was defined as pancreas-specific complications including pancreatic fistula, intra-abdominal abscess, postoperative hemorrhage, and bile leak. The diagnostic accuracy of serum C-reactive protein on postoperative day 1 in predicting adverse postoperative outcomes was assessed by ROC curve analysis.

Results

Six patients (5%) died and 87 (79%) experienced postoperative complications (pancreatic-specific complications: n = 58 (53%); pancreatic fistula: n = 48 (44%)). A soft pancreatic gland texture, a main pancreatic duct diameter < 3 mm and serum C-reactive protein ≥ 100 mg/L on postoperative day 1 were independent predictors of pancreas-specific complications (p < 0.01) and pancreatic fistula (p < 0.01). ROC analysis showed that serum C-reactive protein ≥ 100 mg/L on postoperative day 1 was a significant predictor of pancreatic fistula (AUC: 0.70; 95%CI: 0.60–0.79, p < 0.01) and pancreas-specific complications (AUC: 0.72; 95%CI: 0.62–0.82, p < 0.01). ROC analysis showed that serum C-reactive protein ≥ 50 mg/L at discharge was a significant predictor of 90-day hospital readmission (AUC: 0.70; 95%CI: 0.60–0.79, p < 0.01).

Conclusions

C-reactive protein levels reliably predict risks of pancreatic fistula, pancreas-specific complications, and hospital readmission, and should be inserted in risk-stratified management algorithms after pancreaticoduodenectomy.

Witkowski ER, Smith JK, Tseng JF. Outcomes following resection of pancreatic cancer. J Surg Oncol 2013; 107: 97–103.CrossRefPubMed

Hoem D, Viste A. Improving survival following surgery for pancreatic ductal adenocarcinoma a ten-year experience. Eur J Surg Oncol 2012 ; 38 : 245–251.CrossRefPubMed

Yeo CJ, Cameron JL, Sohn TA, Lillemoe KD, Pitt HA, Talamini MA, Hruban RH, Ord SE, Sauter PK, Coleman J, Zahurak ML, Grochow LB, Abrams RA. Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Ann Surg 1997; 226: 248–260.CrossRefPubMedPubMedCentral

Bassi C, Falconi M, Salvia R, Mascetta G, Molinari E, Pederzoli P. Management of complications after pancreaticoduodenectomy in a high volume centre: results on 150 consecutive patients. Dig Surg 2001; 18: 453–457.CrossRefPubMed

Fong ZV, Ferrone CR, Thayer SP, Wargo JA, Sahora K, Seefeld KJ, Warshaw AL, Lillemoe KD, Hutter MM, Fernandez-Del Castillo C. Understanding hospital readmissions after pancreaticoduodenectomy: can we prevent them? A 10-year contemporary experience with 1,173 patients at the massachusetts general hospital. J Gastrointest Surg 2014; 18: 137–144.CrossRefPubMed

McPhee JT, Hill JS, Whalen GF, Zayaruzny M, Litwin DE, Sullivan ME, Anderson FA, Tseng JF. Perioperative mortality for pancreatectomy: a national perspective. Ann Surg 2007; 246: 246–253.CrossRefPubMedPubMedCentral

Gouma DJ, Van Geenen RC, Van Gulik TM, de Haan RJ, de Wit LT, Busch OR, Obertop H. Rates of complications and death after pancreaticoduodenectomy: risk factors and the impact of hospital volume. Ann Surg 2000; 232: 786–795.CrossRefPubMedPubMedCentral

De Oliveira ML, Winter JM, Schafer M, Cunningham SC, Cameron JL, Yeo CJ, Clavien PA. Assessment of complications after pancreatic surgery: a novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann Surg 2006; 244: 931–937.CrossRef

Simons JP, Shah SA, Ng SC, Whalen GF, Tseng JF. National complication rates after pancreatectomy: beyond mere mortality. J Gastrointest Surg 2009, 13:1798–805.CrossRefPubMed

10.

Grobmyer SR, Pieracci FM, Allen PJ, Brennan MF, Jaques DP. Defining morbidity after pancreaticoduodenectomy: use of a prospective complication grading system. J Am Coll Surg 2007; 204: 356–364.CrossRefPubMed

11.

de Castro SM, Busch OR, van Gulik TM, Obertop H, Gouma DJ. Incidence and management of pancreatic leakage after pancreatoduodenectomy. Br J Surg 2005; 92: 1117–1123.CrossRefPubMed

12.

Harnoss JC, Ulrich AB, Harnoss JM, Diener MK, Büchler MW, Welsch T. Use and results of consensus definitions in pancreatic surgery: a systematic review. Surgery 2014; 155: 47–57.CrossRefPubMed

13.

Winter JM, Cameron JL, Campbell KA, Arnold MA, Chang DC, Coleman J, Hodgin MB, Sauter PK, Hruban RH, Riall TS, Schulick RD, Choti MA, Lillemoe KD, Yeo CJ. 1423 pancreaticoduodenectomies for pancreatic cancer: a single-institution experience. J Gastrointest Surg 2006; 10: 1199–1210.CrossRefPubMed

14.

Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 2005; 138: 8–13.CrossRefPubMed

15.

Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M, Allen P, Andersson R, Asbun HJ, Besselink MG, Conlon K, Del Chiaro M, Falconi M, Fernandez-Cruz L, Fernandez-Del Castillo C, Fingerhut A, Friess H, Gouma DJ, Hackert T, Izbicki J, Lillemoe KD, Neoptolemos JP, Olah A, Schulick R, Shrikhande SV, Takada T, Takaori K, Traverso W, Vollmer CR, Wolfgang CL, Yeo CJ, Salvia R, Buchler M. The International Study Group on Pancreatic Surgery (ISGPS). The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery 2017; 161: 584–591.CrossRefPubMed

16.

Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M; Early Goal-Directed Therapy Collaborative Group. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001; 345: 1368–1377.CrossRefPubMed

17.

Coolsen MM, van Dam RM, van der Wilt AA, Slim K, Lassen K, Dejong CH. Systematic review and meta-analysis of enhanced recovery after pancreatic surgery with particular emphasis on pancreaticoduodenectomies. World J Surg 2013; 37: 1909–1918.CrossRefPubMed

18.

Kagedan DJ, Ahmed M, Devitt KS, Wei AC. Enhanced recovery after pancreatic surgery: a systematic review of the evidence. HPB 2015; 17: 11–16.CrossRefPubMed

19.

Williamsson C, Karlsson N, Sturesson C, Lindell G, Andersson R, Tingstedt B. Impact of a fast-track surgery programme for pancreaticoduodenectomy. Br J Surg 2015; 102: 1133–1141.CrossRefPubMed

20.

Bassi C, Molinari E, Malleo G, Crippa S, Butturini G, Salvia R, Talamini G, Pederzoli P. Early versus late drain removal after standard pancreatic resections: results of a prospective randomized trial. Ann Surg 2010; 252: 207–214.CrossRefPubMed

21.

Kawai M, Tani M, Terasawa H, Ina S, Hirono S, Nishioka R, Miyazawa M, Uchiyama K, Yamaue H. Early removal of prophylactic drains reduces the risk of intra-abdominal infections in patients with pancreatic head resection: prospective study for 104 consecutive patients. Ann Surg 2006; 244: 1–7.CrossRefPubMedPubMedCentral

22.

McMillan MT, Malleo G, Bassi C, Allegrini V, Casetti L, Drebin JA, Esposito A, Landoni L, Lee MK, Pulvirenti A, Roses RE, Salvia R, Vollmer CM Jr. Multicenter, prospective trial of selective drain management for pancreatoduodenectomy using risk stratification. Ann Surg 2017; 265:1209–1218.CrossRefPubMed

23.

Yang J, Huang Q, Wang C. Postoperative drain amylase predicts pancreatic fistula in pancreatic surgery: a systematic review and meta-analysis. Int J Surg 2015; 22: 38–45.CrossRefPubMed

24.

Palani Velu LK, Chandrabalan VV, Jabbar S, Mc Millan DC, Mc Kay CJ, Carter CR, Jamieson NB, Dickson EJ. Serum amylase on the night of surgery predicts clinically significant pancreatic fistula after pancreaticoduodenectomy. HPB 2014; 16: 610–619.CrossRefPubMed

25.

Hiyoshi M, Chijiiwa K, Fujii Y, Imamura N, Nagano M, Ohuchida J. Usefulness of drain amylase, serum C-reactive protein levels and body temperature to predict postoperative pancreatic fistula after pancreaticoduodenectomy. World J Surg 2013; 37: 2436–2442.CrossRefPubMed

26.

Palani Velu LK, Mc Kay CJ, Carter CR, Mc Millan DC, Jamieson NB, Dickson EJ. Serum amylase and C-reactive protein in risk stratification of pancreas-specific complications after pancreaticoduodenectomy. Br J Surg 2016; 103: 553–563.CrossRefPubMed

27.

Giardino A, Spolverato G, Regi P, Frigerio I, Scopelliti F, Girelli R, Pawlik Z, Pederzoli P, Bassi C, Butturini G. C-reactive protein and procalcitonin as predictors of postoperative inflammatory complications after pancreatic surgery. J Gastrointest Surg 2016; 20: 1482–1492.CrossRefPubMed

28.

Sauvanet A, Boher J, Paye F, Bachellier P, Sa Cuhna A, Le Treut YP, Adham M, Mabrut JY, Chiche L, Delpero JR. The French Association of Surgery. Severe jaundice increases early severe morbidity and decreases long-term survival after pancreaticoduodenectomy for pancreatic adenocarcinoma. J Am Coll Surg 2015; 221: 380–389.CrossRefPubMed

29.

Iacono C, Ruzzenente A, Campagnaro T, Bortolasi L, Valdegamberi A, Guglielmi A. Role of preoperative biliary drainage in jaundiced patients who are candidates for pancreatoduodenectomy or hepatic resection. Ann Surg 2013; 257: 191–204.CrossRefPubMed

30.

van der Gaag NA, Rauws EA, van Eijck CH, Bruno MJ, van der Harst E, Kubben FJ, Gerritsen JJ, Greve JW, Gerhards MF, de Hingh IH, Klinkenbijl JH, Nio CY, de Castro SM, Busch OR, van Gulik TM, Bossuyt PM, Gouma DJ. Preoperative biliary drainage for cancer of the head of the pancreas. N Engl J Med 2010; 362:129–137.CrossRefPubMed

31.

Japan Pancreas Society. Classification of pancreatic carcinoma (1st English edn). Kanehara : Tokyo, 1996.

32.

Schwarz L, Lupinacci RM, Svrcek M, Lesurtel M, Bubenheim M, Vuarnesson H, Balladur P, Paye F. Para-aortic lymph node sampling in pancreatic head adenocarcinoma. Br J Surg. 2014; 101: 530–538.CrossRefPubMed

33.

Gayral F, Campion JP, Regimbeau JM, Blumberg J, Maisonobe P, Topart P, Wind P. Randomized, placebo-controlled, double-blind study of the efficacy of lanreotide 30 mg PR in the treatment of pancreatic and enterocutaneous fistulae. Ann Surg 2009; 250:872–877.CrossRefPubMed

34.

Wente MN, Veit JA, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Yeo CJ, Büchler MW. Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery 2007; 142: 20–25.CrossRefPubMed

35.

Yekebas EF, Wolfram L, Cataldegirmen G, Habermann CR, Bogoevski D, Koenig AM, Kaifi J, Schurr PG, Bubenheim M, Nolte-Ernsting C, Adam G, Izbicki JR. Postpancreatectomy Hemorrhage: diagnosis and treatment: an analysis in 1669 consecutive pancreatic resections. Ann Surg 2007; 246: 269–280.CrossRefPubMedPubMedCentral

36.

Wente MD, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Traverso LW, Yeo CJ, Büchler MW. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 2007; 142: 761–768.CrossRefPubMed

37.

Diener MK, Tadjalli-Mehr K, Wente MN, Kieser M, Büchler MW, Seiler CM. Risk–benefit assessment of closed intra-abdominal drains after pancreatic surgery: a systematic review and meta-analysis assessing the current state of evidence. Langenbecks Arch Surg 2011; 396: 41–52.CrossRefPubMed

38.

Correa-Gallego C, Brennan MF, D’Angelica M, Fong Y, Dematteo RP, Kingham TP, Jarnagin WR, Allen PJ. Operative drainage following pancreatic resection: analysis of 1122 patients resected over 5 years at a single institution. Ann Surg 2013; 258: 1051–1058.CrossRefPubMedPubMedCentral

39.

Van Buren G, Bloomston M, Hughes SJ, Winter J, Behrman SW, Zyromski NJ, Vollmer C, Velanovich V, Riall T, Muscarella P, Trevino J, Nakeeb A, Schmidt CM, Behrns K, Ellison EC, Barakat O, Perry KA, Drebin J, House M, Abdel-Misih S, Silberfein EJ, Goldin S, Brown K, Mohammed S, Hodges SE, McElhany A, Issazadeh M, Jo E, Mo Q, Fisher WE. A randomized prospective multicenter trial of pancreaticoduodenectomy with and without routine intraperitoneal drainage. Ann Surg 2014; 259: 605–612.CrossRefPubMed

40.

Pratt WB, Callery MP, Vollmer CM Jr. Risk prediction for development of pancreatic fistula using the ISGPF classification scheme. World J Surg 2008; 32: 419–428.CrossRefPubMed

41.

Sulpice L, Rayar M, D’Halluin PN, Harnoy Y, Merdrignac A, Bretagne JF, Meunier B, Boudjema K. Impact of age over 75 years on outcomes after pancreaticoduodenectomy. J Surg Res 2012; 178: 181–187.CrossRefPubMed

42.

Lermite E, Pessaux P, Brehant O, Teyssedou C, Pelletier I, Etienne S, Arnaud JP. Risk factors of pancreatic fistula and delayed gastric emptying after pancreaticoduodenectomy with pancreaticogastrostomy. J Am Coll Surg 2007; 204: 588–596.CrossRefPubMed

43.

Ausania F, Snowden CP, Prentis JM, Holmes LR, Jaques BC, White SA, French JJ, Manas DM, Charnley RM. Effects of low cardiopulmonary reserve on pancreatic leak following pancreaticoduodenectomy. Br J Surg 2012; 99: 1290–1294.CrossRefPubMed

44.

Motoi F, Egawa S, Rikiyama T, Katayose Y, Unno M. Randomized clinical trial of external stent drainage of the pancreatic duct to reduce postoperative pancreatic fistula after pancreaticojejunostomy. Br J Surg 2012; 99: 524–531.CrossRefPubMed

45.

Yang YM, Tian XD, Zhuang Y, Wang WM, Wan YL, Huang YT. Risk factors of pancreatic leakage after pancreaticoduodenectomy. World J Gastroenterol 2005; 11: 2456–2461.CrossRefPubMedPubMedCentral

46.

Liang TB, Bai XL, Zheng SS. Pancreatic fistula after pancreaticoduodenectomy: diagnosed according to International Study Group Pancreatic Fistula (ISGPF) definition. Pancreatology 2007; 7: 325–331.CrossRefPubMed

47.

Rosso E, Casnedi S, Pessaux P, Oussoultzoglou E, Panaro F, Mahfud M, Jaeck D, Bachellier P. The role of “fatty pancreas” and of BMI in the occurrence of pancreatic fistula after pancreaticoduodenectomy. J Gastrointest Surg 2009; 13: 1845–1851.CrossRefPubMed

48.

Raty S, Sand J, Lantto E, Nordback I. Postoperative acute pancreatitis as a major determinant of postoperative delayed gastric emptying after pancreaticoduodenectomy. J Gastrointest Surg 2006; 10: 1131–1139.CrossRefPubMed

49.

Pecorelli N, Balzano G, Capretti G, Zerbi A, Di Carlo V, Braga M. Effect of surgeon volume on outcome following pancreaticoduodenectomy in a high-volume hospital. J Gastrointest Surg 2012; 16: 518–523.CrossRefPubMed

50.

Welsch T, Frommhold K, Hinz U, Weigand MA, Kleeff J, Friess H, Büchler MW, Schmidt J. Persisting elevation of C-reactive protein after pancreatic resections can indicate developing inflammatory complications. Surgery 2008; 143: 20–28.CrossRefPubMed

51.

Cloyd JM, Kastenberg ZJ, Visser BC, Poultsides GA, Norton JA. Postoperative serum amylase predicts pancreatic fistula formation following pancreaticoduodenectomy. J Gastrointest Surg 2014; 18: 348–353.CrossRefPubMed

52.

Uemura K, Murakami Y, Sudo T, Hashimoto Y, Kondo N, Nakagawa N, Sasaki H, Ohge H, Sueda T. Indicators for proper management of surgical drains following pancreaticoduodenectomy. J Surg Oncol 2014; 109: 702–707.CrossRefPubMed

53.

Ansorge C, Nordin JZ, Lundell L, Strömmer L, Rangelova E, Blomberg J, Del Chiaro M, Segersvärd R. Diagnostic value of abdominal drainage in individual risk assessment of pancreatic fistula following pancreaticoduodenectomy. Br J Surg 2014; 101: 100–108.CrossRefPubMed

54.

Kawai M, Kondo S, Yamaue H, Wada K, Sano K, Motoi F, Unno M, Satoi S, Kwon AH, Hatori T, Yamamoto M, Matsumoto J, Murakami Y, Doi R, Ito M, Miyakawa S, Shinchi H, Natsugoe S, Nakagawara H, Ohta T, Takada T. Predictive risk factors for clinically relevant pancreatic fistula analyzed in 1,239 patients with pancreaticoduodenectomy: multicenter data collection as a project study of pancreatic surgery by the Japanese Society of Hepato-Biliary-Pancreatic Surgery. J Hepatobiliary Pancreat Sci 2011; 18: 601–608.CrossRefPubMed

55.

Molinari E, Bassi C, Salvia R, Butturini G, Crippa S, Talamini G, Falconi M, Pederzoli P. Amylase value in drains after pancreatic resection as predictive factor of postoperative pancreatic fistula results of a prospective study in 137 patients. Ann Surg 2007; 246: 281–287.CrossRefPubMedPubMedCentral

56.

Kawai M, Tani M, Hirono S, Ina S, Miyazawa M, Yamaue H. How do we predict the clinically relevant pancreatic fistula after pancreaticoduodenectomy? An analysis in 244 consecutive patients. World J Surg 2009; 33: 2670–2678.CrossRefPubMed

57.

Dalla Valle R, De Bellis M, Pedrazzi G, Lamecchi L, Bianchi G, Pellegrino C, Iaria M. Can early serum lipase measurement be routinely implemented to rule out clinically significant pancreatic fistula after pancreaticoduodenectomy? Int J Surg 2015; 21: 50–54.CrossRef

58.

Lu X, Wang X, Fang Y, Chen H, Peng C, Li H, Deng X, Shen B. Systematic review and meta-analysis of pancreatic amylase value on postoperative day 1 after pancreatic resection to predict postoperative pancreatic fistula. Medicine 2016; 95(5):e2569.CrossRefPubMedPubMedCentral

59.

Ahmad SA, Edwards MJ, Sutton JM, Grewal SS, Hanseman DJ, Maithel SK, Patel SH, Bentram DJ, Weber SM, Cho CS, Winslow ER, Scoggins CR, Martin RC, Kim HJ, Baker JJ, Merchant NB, Parikh AA, Kooby DA. Factors influencing readmission after pancreaticoduodenectomy: a multi-institutional study of 1302 patients. Ann Surg 2012; 256: 529–537.CrossRefPubMed

60.

Emick DM, Riall TS, Cameron JL, Winter JM, Lillemoe KD, Coleman J, Sauter PK, Yeo CJ. Hospital readmission after pancreaticoduodenectomy. J Gastrointest Surg 2006; 10: 1243–1253.CrossRefPubMed

61.

van Geenen RC, van Gulik TM, Busch OR, de Wit LT, Obertop H, Gouma DJ. Readmissions after pancreatoduodenectomy. Br J Surg 2001; 88: 1467–1471.CrossRefPubMed

Titel: C-Reactive Protein on Postoperative Day 1 Is a Reliable Predictor of Pancreas-Specific Complications After Pancreaticoduodenectomy
verfasst von: Théophile Guilbaud
David Jérémie Birnbaum
Coralie Lemoine
Mircea Chirica
Olivier Risse
Stéphane Berdah
Edouard Girard
Vincent Moutardier
Publikationsdatum: 04.01.2018
Verlag: Springer US
Erschienen in: Journal of Gastrointestinal Surgery / Ausgabe 5/2018
Print ISSN: 1091-255X
Elektronische ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-017-3658-9

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