High serum CA19-9 preoperatively reduces POPF risk after pancreatoduodenectomy in PDAC

被引：1

作者：

Chikhladze, S. ^{[1
]}

Hipp, J. ^{[1
]}

Biesel, E. ^{[1
]}

Weckler, M. ^{[1
]}

Ruess, D. A. ^{[1
]}

Kousoulas, L. ^{[1
]}

Hopt, U. ^{[1
]}

Fichtner-Feigl, S. ^{[1
]}

Wittel, U. A. ^{[1
]}

机构：

[1] Univ Freiburg, Dept Gen & Visceral Surg, Med Ctr & Fac Med, D-79106 Freiburg, Germany

来源：

SURGERY IN PRACTICE AND SCIENCE | 2022年 / 8卷

关键词：

POSTOPERATIVE PANCREATIC FISTULA; INTERNATIONAL STUDY-GROUP; SURGICAL COMPLICATIONS; SCORING SYSTEM; CLASSIFICATION; METAANALYSIS; DEFINITION; VALIDATION; PREDICTION; OUTCOMES;

D O I：

10.1016/j.sipas.2021.100051

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

Background: Recent groundbreaking work revealed CA19-9 is not only a tumor marker for PDAC. It also induces severe pancreatitis and promotes pancreatic fibrosis. The aim of this study was evaluation if due fibrosis CA19-9 may stratify for reduced postoperative pancreatic fistula (POPF) risk. Material and Methods: Retrospective analysis of our institutional database of 954 consecutive patients having undergone PD between 2001 and 2018. Potential risk factors for POPF were evaluated. 436 (46%) patients with pancreatic ductal adenocarcinoma (PDAC) were analysed separately. POPF rate, degree of pancreatic fibrosis, inflammation and acinar cell area at the cut edge of pancreas (CEP) were investigated in correlation of CA19-9. Results: The median age was 67 (range 9-89) years. 533 (56%) were male, 22% of patients developed clinically relevant POPF (CR-POPF). Overall postoperative mortality was 3.4%. Elevated preoperative CA19-9, elevated bilirubin and postoperative low serum amylase were significantly (p<0.01) associated with a reduced POPF rate in patients with PDAC. In addition, elevated CA19-9 was significantly associated with more pancreatic fibrosis (p<0.02), inflammation (p<0.01) and acinar atrophy (p<0.01). Conclusion: In our experience, increased CA19-9 correlates with pancreatic fibrosis and reduced CR-POPF. CA19-9 could be complementary for preoperative POPF-scores.

引用

页数：6

共 45 条

[1] Pancreas fistula risk prediction: implications for hospital costs and payments [J].

Abbott, Daniel E. ;

Tzeng, Ching Wei D. ;

McMillan, Matthew T. ;

Callery, Mark P. ;

Kent, Tara S. ;

Christein, John D. ;

Behrman, Stephen W. ;

Schauer, Daniel P. ;

Hanseman, Dennis J. ;

Eckman, Mark H. ;

Vollmer, Charles M. .

HPB, 2017, 19 (02) :140-146

[2] Structured intraoperative assessment of pancreatic gland characteristics in predicting complications after pancreaticoduodenectomy [J].

Ansorge, C. ;

Strommer, L. ;

Andren-Sandberg, A. ;

Lundell, L. ;

Herrington, M. K. ;

Segersvard, R. .

BRITISH JOURNAL OF SURGERY, 2012, 99 (08) :1076-1082

[3] Surgical Apgar Score Predicts Perioperative Morbidity in Patients Undergoing Pancreaticoduodenectomy at a High-Volume Center [J].

Assifi, M. Mura ;

Lindenmeyer, John ;

Leiby, Benjamin E. ;

Grunwald, Zvi ;

Rosato, Ernest L. ;

Kennedy, Eugene P. ;

Yeo, Charles J. ;

Berger, Adam C. .

JOURNAL OF GASTROINTESTINAL SURGERY, 2012, 16 (02) :275-281

[4] The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After [J].

Bassi, Claudio ;

Marchegiani, Giovanni ;

Dervenis, Christos ;

Sarr, Micheal ;

Abu Hilal, Mohammad ;

Adham, Mustapha ;

Allen, Peter ;

Andersson, Roland ;

Asbun, Horacio J. ;

Besselink, Marc G. ;

Conlon, Kevin ;

Del Chiaro, Marco ;

Falconi, Massimo ;

Fernandez-Cruz, Laureano ;

Fernandez-Del Castillo, Carlos ;

Fingerhut, Abe ;

Friess, Helmut ;

Gouma, Dirk J. ;

Hackert, Thilo ;

Izbicki, Jakob ;

Lillemoe, Keith D. ;

Neoptolemos, John P. ;

Olah, Attila ;

Schulick, Richard ;

Shrikhande, Shailesh V. ;

Takada, Tadahiro ;

Takaori, Kyoichi ;

Traverso, William ;

Vollmer, Charles ;

Wolfgang, Christopher L. ;

Yeo, Charles J. ;

Salvia, Roberto ;

Buehler, Marcus .

SURGERY, 2017, 161 (03) :584-591

[5] A Prospectively Validated Clinical Risk Score Accurately Predicts Pancreatic Fistula after Pancreatoduodenectomy [J].

Callery, Mark P. ;

Pratt, Wande B. ;

Kent, Tara S. ;

Chaikof, Elliot L. ;

Vollmer, Charles M., Jr. .

JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS, 2013, 216 (01) :1-14

[6]

Casciani F, 2021, Surgery, VS0039-6060

[7] Surgeon experience contributes to improved outcomes in pancreatoduodenectomies at high risk for fistula development [J].

Casciani, Fabio ;

Trudeau, Maxwell T. ;

Asbun, Horacio J. ;

Ball, Chad G. ;

Bassi, Claudio ;

Behrman, Stephen W. ;

Berger, Adam C. ;

Bloomston, Mark P. ;

Callery, Mark P. ;

Christein, John D. ;

Falconi, Massimo ;

Fernandez-del Castillo, Carlos ;

Dillhoff, Mary E. ;

Dickson, Euan J. ;

Dixon, Elijah ;

Fisher, William E. ;

House, Michael G. ;

Hughes, Steven J. ;

Kent, Tara S. ;

Malleo, Giuseppe ;

Partelli, Stefano ;

Salem, Ronald R. ;

Stauffer, John A. ;

Wolfgang, Christopher L. ;

Zureikat, Amer H. ;

Vollmer, Charles M., Jr. .

SURGERY, 2021, 169 (04) :708-720

[8] Perioperative Immunization for Splenectomy and the Surgeon's Responsibility A Review [J].

Casciani, Fabio ;

Trudeau, Maxwell T. ;

Vollmer, Charles M., Jr. .

JAMA SURGERY, 2020, 155 (11) :1068-1077

[9] The Clavien-Dindo Classification of Surgical Complications Five-Year Experience [J].

Clavien, Pierre A. ;

Barkun, Jeffrey ;

de Oliveira, Michelle L. ;

Vauthey, Jean Nicolas ;

Dindo, Daniel ;

Schulick, Richard D. ;

de Santibanes, Eduardo ;

Pekolj, Juan ;

Slankamenac, Ksenija ;

Bassi, Claudio ;

Graf, Rolf ;

Vonlanthen, Rene ;

Padbury, Robert ;

Cameron, John L. ;

Makuuchi, Masatoshi .

ANNALS OF SURGERY, 2009, 250 (02) :187-196

[10] A grading system can predict clinical and economic outcomes of pancreatic fistula after pancreaticoduodenectomy: results in 755 consecutive patients [J].

Daskalaki, Despoina ;

Butturini, Giovanni ;

Molinari, Enrico ;

Crippa, Stefano ;

Pederzoli, Paolo ;

Bassi, Claudio .

LANGENBECKS ARCHIVES OF SURGERY, 2011, 396 (01) :91-98

← 1 2 3 4 5 →