Abstract：
BACKGROUND: /Objectives: This study aimed to evaluate the frequency, clinical impact, and risk factors of post-pancreatectomy acute pancreatitis (PPAP) after pancreatoduodenectomy (PD) according to the definition proposed by the International Study Group for Pancreatic Surgery (ISGPS).
METHODS: patients undergoing PD between 2010 and 2021 were retrospectively analyzed. PPAP was defined according to the ISGPS criteria, including elevated serum amylase for 48 h and concurring pancreatitis alterations on a CT scan.
RESULTS: 272 patients were finally included in the study. PPAP occurred in 40 (14.7 %) patients, and it was significantly related to higher rates of clinically-relevant postoperative pancreatic fistula (CR-POPF) (p < 0.001), post-pancreatectomy hemorrhage (PPH) (p < 0.001) and major complications (Clavien-Dindo ≥ 3a) (p < 0.001). Moreover, PPAP in the absence of CR-POPF (n = 18) was significantly related to longer hospital stay (p < 0.001), PPH (p < 0.001), major complications (Clavien-Dindo≥ 3a, p = 0.001) and higher intensive care unit costs (p = 0.029) compared to patients not developing PPAP. In the univariable and multivariable analysis, the duct size (p = 0.004) and high-risk pathologies (p = 0.004) but not intraoperative bleeding (p = 0.066) represented independent risk factors for PPAP. In the same analysis, patients receiving a bridging therapy with low molecular-weight heparin showed significantly lower rates of PPAP (p = 0.045).
CONCLUSIONS: PPAP represents a relevant complication after PD. Its risk factors are similar to those for CR-POPF, while anticoagulants could represent a possible prevention strategy.
METHODS: patients undergoing PD between 2010 and 2021 were retrospectively analyzed. PPAP was defined according to the ISGPS criteria, including elevated serum amylase for 48 h and concurring pancreatitis alterations on a CT scan.
RESULTS: 272 patients were finally included in the study. PPAP occurred in 40 (14.7 %) patients, and it was significantly related to higher rates of clinically-relevant postoperative pancreatic fistula (CR-POPF) (p < 0.001), post-pancreatectomy hemorrhage (PPH) (p < 0.001) and major complications (Clavien-Dindo ≥ 3a) (p < 0.001). Moreover, PPAP in the absence of CR-POPF (n = 18) was significantly related to longer hospital stay (p < 0.001), PPH (p < 0.001), major complications (Clavien-Dindo≥ 3a, p = 0.001) and higher intensive care unit costs (p = 0.029) compared to patients not developing PPAP. In the univariable and multivariable analysis, the duct size (p = 0.004) and high-risk pathologies (p = 0.004) but not intraoperative bleeding (p = 0.066) represented independent risk factors for PPAP. In the same analysis, patients receiving a bridging therapy with low molecular-weight heparin showed significantly lower rates of PPAP (p = 0.045).
CONCLUSIONS: PPAP represents a relevant complication after PD. Its risk factors are similar to those for CR-POPF, while anticoagulants could represent a possible prevention strategy.
摘要：
背景：/目标：本研究旨在评估频率，临床影响，根据国际胰腺外科研究小组（ISGPS）提出的定义，胰十二指肠切除术（PD）后胰腺切除术后急性胰腺炎（PPAP）的危险因素。
方法：对2010-2021年接受PD的患者进行回顾性分析。PPAP是根据ISGPS标准定义的，包括48小时的血清淀粉酶升高和CT扫描上并发的胰腺炎改变。
结果：272名患者最终被纳入研究。40例（14.7%）患者发生PPAP，并且与临床相关的术后胰瘘（CR-POPF）的发生率显着相关（p<0.001），胰腺切除术后出血（PPH）（p<0.001）和主要并发症（Clavien-Dindo≥3a）（p<0.001）。此外，缺乏CR-POPF的PPAP（n=18）与更长的住院时间显着相关（p<0.001），PPH（p<0.001），主要并发症（Clavien-Dindo≥3a，与未发生PPAP的患者相比，p=0.001）和更高的重症监护病房费用（p=0.029）。在单变量和多变量分析中，导管大小(p=0.004)和高危病理(p=0.004),而非术中出血(p=0.066)是PPAP的独立危险因素.在同样的分析中，接受低分子肝素桥接治疗的患者PPAP发生率显著降低(p=0.045).
结论：PPAP代表PD后的相关并发症。其危险因素与CR-POPF相似，而抗凝剂可能是一种可能的预防策略。
方法：对2010-2021年接受PD的患者进行回顾性分析。PPAP是根据ISGPS标准定义的，包括48小时的血清淀粉酶升高和CT扫描上并发的胰腺炎改变。
结果：272名患者最终被纳入研究。40例（14.7%）患者发生PPAP，并且与临床相关的术后胰瘘（CR-POPF）的发生率显着相关（p<0.001），胰腺切除术后出血（PPH）（p<0.001）和主要并发症（Clavien-Dindo≥3a）（p<0.001）。此外，缺乏CR-POPF的PPAP（n=18）与更长的住院时间显着相关（p<0.001），PPH（p<0.001），主要并发症（Clavien-Dindo≥3a，与未发生PPAP的患者相比，p=0.001）和更高的重症监护病房费用（p=0.029）。在单变量和多变量分析中，导管大小(p=0.004)和高危病理(p=0.004),而非术中出血(p=0.066)是PPAP的独立危险因素.在同样的分析中，接受低分子肝素桥接治疗的患者PPAP发生率显著降低(p=0.045).
结论：PPAP代表PD后的相关并发症。其危险因素与CR-POPF相似，而抗凝剂可能是一种可能的预防策略。
