Preoperative acute pancreatitis in periampullary tumors: implications for surgical management.
BACKGROUND
Pancreatitis is the most serious complication of endoscopic retrograde cholangiopancreatography (ERCP), occurring in 2-20% of the patients. Currently there is no information about the impact of preoperative pancreatitis on the surgical management of periampullary tumors.


METHODS
Ten patients with periampullary tumors and preoperative acute pancreatitis were retrospectively analyzed. Four patients who underwent pylorus-preserving pancreaticoduodenectomy (group A) and 6 patients who underwent total pancreatectomy (group B) were compared with a matching control group (age, gender, stage, tumor and operation type) of 30 patients without pancreatitis (group C) who underwent an operation during the same period. Parameters analyzed were C-reactive protein (CRP), leukocytes, aminotransferases, amylase, lipase, operative time, blood loss, hospital stay, morbidity, and mortality.


RESULTS
In the study group, 5 patients had pancreatic adenocarcinoma, 3 had distal bile duct cancers, and 2 had ampullary tumors. None of the patients had severe acute necrotizing pancreatitis that necessitated intervention prior to tumor resection. Preoperative median CRP levels in group B were 8.4- and 5.6-fold higher than those of groups A and C, respectively. In contrast, leukocytes, aminotransferases, amylase, and lipase levels were not significantly different. The presence of acute pancreatitis slightly prolonged the duration of the operation (+15 min), increased morbidity (60 vs. 33%) and lengthened median hospital stay (19.5 vs. 14.5 days) in groups A and B vs. group C. All patients with preoperative pancreatitis were managed without mortality.


CONCLUSIONS
Preoperative pancreatitis is more commonly seen in patients with non-pancreatic periampullary tumors, and considerably influences surgical management. High preoperative CRP levels indicate a more severe form of pancreatic damage that may necessitate a total pancreatectomy.
Erkan
Mert
M
Department of General Surgery, University of Heidelberg, Heidelberg, Germany.
Kleeff
Jörg
J
Reiser
Carolin
C
Hinz
Ulf
U
Esposito
Irene
I
Friess
Helmut
H
Büchler
Markus W
MW
D000208:Acute Disease; D000368:Aged; D014670:Ampulla of Vater / Q000601:surgery*; D016022:Case-Control Studies; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects; D003138:Common Bile Duct Neoplasms / Q000150:complications* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D015607:Stents; D016896:Treatment Outcome