title: Postoperative biological and clinical outcomes following uncomplicated pancreaticoduodenectomy.
abstract: OBJECTIVE
  The aim of this study was to describe clinical and biological changes in a group of patients who underwent pancreaticoduodenectomy (PD) without any complication during the postoperative period. These changes reflect the "natural history" of PD, and a deviation should be considered as a warning sign.
  
  
  METHODS
  Between January 2000 and December 2009, 131 patients underwent PD. We prospectively collected and retrospectively analyzed demographic data, pathological variables, associated pathological conditions, and preoperative, intraoperative, and postoperative variables. Postoperative variables were validated using an external prospective database of 158 patients.
  
  
  RESULTS
  The mean postoperative length of hospital stay was 20.3±4 days. The mean number of days until removal of nasogastric tube was 6.3±1.6 days. The maximal fall in hemoglobin level occurred on day 3 and began to increase after postoperative day (POD) 5, in patients with or without transfusions. The white blood cell count increased on POD 1 and persisted until POD 7. There was a marked rise in aminotransferase levels at POD 3. The peak was significantly higher in patients with hepatic pedicle occlusion (866±236 IU/L versus 146±48 IU/L; p<0.001). For both γ-glutamyl transpeptidase and alkaline phosphatase, there was a fall on POD1, which persisted until POD 5, followed with a stabilization. Bilirubin decreased progressively from POD 1 onwards.
  
  
  CONCLUSIONS
  This study facilitates a standardized biological and clinical pathway of follow-up. Patients who do not follow this recovery indicator could be at risk of complications and additional exams should be made to prevent consequences of such complications.
authors.affiliation: Service de Chirurgie digestive, Hôpital universitaire d'Angers - Université d'Angers, France.
authors.forename: Emilie
authors.initials: E
authors.lastname: Lermite
authors.affiliation: Digestive surgery, Hospital of Kunming - Medical University - Kunming - China.
authors.forename: Tao
authors.initials: T
authors.lastname: Wu
authors.affiliation: Service de Chirurgie Hépatobiliopancréatique, Hôpital Beaujon - Université Paris VII, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Sauvanet
authors.affiliation: Service de Chirurgie digestive et oncologique, Hôpital Claude Huriez - Université de Lille, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Mariette
authors.affiliation: Service de Chirurgie générale et digestive, Hôpital Saint-antoine - UPMC Paris VI, France.
authors.forename: François
authors.initials: F
authors.lastname: Paye
authors.affiliation: Service de Chirurgie digestive et de transplantation, Hôpital Rangueil - Université de Toulouse, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Muscari
authors.affiliation: Service de Chirurgie digestive, Hôpital Haut Levêque - Université de Bordeaux, France.
authors.forename: Antonio Sa
authors.initials: AS
authors.lastname: Cunha
authors.affiliation: Service de Chirurgie digestive, Hôpital de la Timone - Université de Marseille, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Sastre
authors.affiliation: Service de Chirurgie digestive, Hôpital universitaire d'Angers - Université d'Angers, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Arnaud
authors.affiliation: Unité de Chirurgie Hépatobiliaire et Pancréatique, Nouvel Hôpital Civil, Université de Strasbourg, IHU MixSurg, IRCAD, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Pessaux
keywords: Biological test; Complication; Natural history; Pancreaticoduodenectomy