title: Pancreatic leakage and acute postoperative pancreatitis after proximal pancreatoduodenectomy.
abstract: BACKGROUND
  Acute postoperative pancreatitis (APP) after proximal pancreatoduodenectomy (PDE) is a major and serious complication. The purpose of the the study is early diagnosis of APP, differentiation from pancreatic stump leak and possibilities of surgical treatment.
  
  
  METHODS
  Of all patients who underwent PDE for ductal adenocarcinoma of the pancreatic head complicated by type C pancreatic leak, who died during primary hospitalization, we used autopsy findings to find patients with histologically confirmed APP. We compared this group to patients with only a pancreatic leak and patients with an uncomplicated clinical course. We retrospectively evaluated the postoperative clinical course, and radiological and laboratory data of all patients. These parameters were statistically compared between the individual groups using Fisher LSD test. We considered p = 0.05 to be statistically significant. Data were analysed using software STATISTICA 10.0 (StatSoft CR s.r.o.).
  
  
  RESULTS
  One hundred sixty patients underwent PDE for ductal adenocarcinoma at our institution between 20072011 and were retrospectivaly reviewed. APP with postoperative type C pancreatic leak was observed in 4 (2.5%) patients; none of these patients survived. We found significantly higher levels of serum pancreatic amylase (AMS) on the 1. postoperative day in 3 of these patients compared to the other groups. Significantly increasing levels of CRP during the the first 5 postoperative days were observed in 75% of these patients. Retrospectively analysed contrast CT scans up to the 5th POD did not show APP. Only 1 patient had findings of APP type E according to Balthazar on CT scan performed on the 9th POD.
  
  
  CONCLUSIONS
  The most significant factor in early diagnosis of APP after PDE is an abrupt change in clinical status. We also observed significantly higher levels of serum concentrations of CRP and AMS. Based on our findings, CT scan is not beneficial in the early diagnosis of APP. In cases of early diagnosed APP after PDE, the question of performing a completion pancreatectomy and its timing remains.
authors.forename: J
authors.initials: J
authors.lastname: Rudis
authors.forename: M
authors.initials: M
authors.lastname: Ryska
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000681:Amylases / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D021441:Carcinoma, Pancreatic Ductal / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D010195:Pancreatitis / Q000175:diagnosis* / Q000453:epidemiology*; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology*; D012189:Retrospective Studies
chemical_list: D002097:C-Reactive Protein; D000681:Amylases