Intraoperative acidosis is a new predictor for postoperative pancreatic fistula after pancreaticoduodenectomy.
BACKGROUND
Early diagnosis of postoperative pancreatic fistula (POPF) is important for proper interventions. The preoperative, intraoperative and early postoperative biochemical markers have predictive value of POPF. The present study was to evaluate several simple biochemical parameters in the prediction of POPF.


METHODS
Patients who underwent pancreaticoduodenectomy in our center between 2006 and 2015 were reviewed retrospectively. Preoperative and early postoperative biochemical parameters were evaluated. Additionally, the relationship between POPF and pH and lactate level at the end of surgery were analyzed, and neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and red cell distribution width-to-platelet ratio (RPR) were calculated for postoperative days (PODs) 1 and 3. Diagnosis and grading of POPF were performed according to the standards of the International Study Group on Pancreatic Fistula. The patients were divided into two groups: Group 1 with no fistula or grade-A fistula; group 2 with grade-B or -C fistula. These simple biochemical markers were then compared between the two groups.


RESULTS
Serum amylase level was significantly higher at POD3, and pH level was significantly lower at the end of operation in group 2 compared with those in group 1. However, the serum amylase was below the upper limit of normal serum level and therefore, the difference was not significant in clinical practice. Receiver operating charecteristic curve analysis showed that pH level was a reliable predictor of POPF (area under the curve: 0.713; 95% CI: 0.573-0.853).


CONCLUSIONS
A low pH level at the end of pancreaticoduodenectomy was a risk factor of POPF. NLR, PLR, and RPR had no predictive value of POPF after pancreaticoduodenectomy.
Istanbul Training and Research Hospital, Department of General Surgery, Istanbul 34098, Turkey. erdemkinaci@gmail.com.
Erdem
E
Kinaci
Mert Mahsuni
MM
Sevinc
Abdulkerim
A
Ozakay
Savas
S
Bayrak
Ekrem
E
Cakar
Serkan
S
Sari
D000140:Acidosis, Lactic / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D000368:Aged; D000681:Amylases / Q000097:blood; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D042241:Early Diagnosis; D004909:Erythrocyte Indices; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D019344:Lactic Acid / Q000097:blood; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D010185:Pancreatic Fistula / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D010976:Platelet Count; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014421:Turkey
D015415:Biomarkers; D019344:Lactic Acid; D000681:Amylases