Clinical impact of preoperative acute pancreatitis in patients who undergo pancreaticoduodenectomy for periampullary tumors

Table 1 Distribution of acute pancreatitis patients who had surgery for a planned laparotomy n (%)

Parameter	Resected (n = 38)	Not resected (n = 20)	P value
Age (yr), mean ± SD	55.92 ± 11.01	20.8 ± 12.18	0.11
Male	16 (57.1)	16 (80)	0.098
Cause of acute pancreatitis			0.049
ERCP	10 (26.3)	1 (5)
Unknown	28 (73.7)	19 (95)
Balthazar CT score	2.05 ± 0.70	2.9 ± 0.85	< 0.001
Grade of severity			0.283
Mild acute pancreatitis	12 (35.3)	6 (30)
Moderately severe acute pancreatitis	19 (55.9)	9 (45)
Severe acute pancreatitis	3 (8.8)	5 (25)
Time to surgery (d), mean ± SD	22.3 ± 17.0	54.6 ± 26.3	< 0.001
Type of operation
Pancreaticoduodenectomy	34 (89.5)
Totle pancreatectomy	4 (10.5)
Bypass procedure		7 (35)
Exploratory laparotomy		13 (65)

ERCP: Endoscopic retrograde cholangiopancreatography; CT: Computed tomography.

Table 2 Demographic data, operation and pathologic characteristics of pancreaticoduodenectomy patients n (%)

Parameter	AP (n = 34)	Control (n = 145)	P value
Patient variables
Age (yr), mean ± SD	55.9 ± 11.26	59.0 ± 10.92	0.131
Male	21 (61.8)	93 (64.1)	0.796
Weight loss	17 (50)	59 (40.7)	0.323
Comorbid disease	9 (26.5)	47 (32.4)	0.501
Preoperative jaundice	11 (32.4)	68 (43.9)	0.124
Pancreas remnant (soft)	29 (85.3)	109 (75.2)	0.206
Pancreatic duct diameter (< 3 mm)	22 (64.7)	92 (63.4)	0.891
Treatment variables
Preoperative biliary drainage	6 (17.6)	11 (7.6)	0.099
Time to surgery (d), mean ± SD	18.4 ± 10.76	6.0 ± 2.5	< 0.001
Intraoperative blood transfusion	11 (32.4)	62 (35.9)	0.700
Vein resection	1 (2.9)	7 (4.8)	0.632
Pathological variables
Characteristics of resectable tumors			0.062
Pancreatic carcinoma	21 (61.8)	58 (40)
Ampullary carcinoma	4 (11.8)	19 (13.1)
Duodenal carcinoma	2 (5.9)	35 (24.1)
Distal bile duct carcinoma	3 (8.8)	18 (12.4)
Other diagnosis	4 (11.8)	15 (10.3)
Benign: malignant ratio	4/30	130/15	1.000
Tumor-positive lymph nodes (N1)	16 (53.3)	39 (30.2)	0.017
Microscopically residual disease (R1)	1 (2.9)	2 (1.4)	0.523

Table 3 Postoperative data of pancreaticoduodenectomy patients n (%)

Parameter	AP (n = 34)	Control (n = 145)	P value
Medical complications	15 (44.1)	53 (36.6)	0.413
Grade of complications			0.086
0-1	24	116
2	5	22
3	4	4
4	2	3
5 Mortality	0	0
Severe complications (grade 3 or more)	6 (17.6)	7 (4.8)	0.019
Pancreatic fistula	10 (29.4)	17 (11.7)	0.009
Grade A	3 (8.8)	8 (5.5)
Grade B	2 (5.9)	7 (4.8)
Grade C	5 (14.7)	2 (1.8)
Grade B/C	7 (20.6)	9 (6.2)	0.015
Biliary leak	1 (2.9)	1 (0.7)	0.345
Delayed gastric emptying	10 (29.4)	28 (19.3)	0.195
Intra-abdominal collection or abscess	7 (20.6)	8 (5.5)	0.010
Hemorrhage after pancreatectomy	5 (14.7)	4 (2.8)	0.013
Gastrointestinal hemorrhage	3 (8.8)	2 (1.4)	0.048
Intra-abdominal hemorrhage	1 (2.9)	2 (1.4)	0.471
Wound infection	8 (23.5)	18 (12.4)	0.098
Intestinal fistula	2 (5.9)	0	0.035
Septicemia	1 (2.9)	5 (3.4)	1.000
Pulmonary complications	5 (14.7)	16 (11)	0.557
Postoperative length of stay (d), mean ± SD	17.4 ± 9.8	13.7 ± 6.1	0.006

Table 4 Risk factors influencing pancreatic fistula after pancreaticoduodenectomy by univariate and multivariate logistic regression analyses

Parameter	Univariate1		Multivariate1
	OR (95%CI)	P value	OR (95%CI)	P value
Age (≥ 70 yr vs < 70 yr)	0.74 (0.24-2.30)	0.738
Sex (male vs female)	0.57 (0.23-1.43)	0.228
Weight loss (yes vs no)	1.10 (0.48-2.51)	0.821
Preoperative jaundice (yes vs no)	1.55 (0.64-3.76)	0.334
Acute pancreatitis (yes vs no)	3.14 (1.28-7.67)	0.012	2.91 (1.10-7.68)	0.032
Blood transfusion (yes vs no)	1.23 (0.53-2.81)	0.632
Comorbid disease (yes vs no)	1.36 (0.58-3.19)	0.485
Preoperative biliary drainage (yes vs no)	4.97 (1.70-14.54)	0.003	3.40 (1.05-10.99)	0.041
Intraoperative blood transfusion (yes vs no)	2.28 (0.99-5.24)	0.052	2.69 (1.08-6.71)	0.034
Histopathologic diagnosis		0.090		NS
Pancreatic carcinoma	1.0
Ampullary carcinoma	1.86 (0.53-6.53)	0.333
Duodenal carcinoma	2.54 (0.83-7.73)	0.022
Distal bile duct carcinoma	3.83 (1.28-11.45)	0.016
Pancreatic texture (soft vs hard)	9.29 (1.22-70.68)	0.031	9.82 (1.22-79.31)	0.032
Pancreatic duct (< 3 mm vs≥ 3 mm)	2.22 (0.85-5.82)	0.105

¹Logistic regression. NS: Not significant.

Table 5 Risk factors influencing severe complications after pancreaticoduodenectomy by univariate and multivariate logistic regression analyses

Parameter	Univariate1		Multivariate1
	OR (95%CI)	P value	OR (95%CI)	P value
Age (≥ 70 yr vs < 70 yr)	0.68 (0.15-3.17)	0.623
Sex (male vs female)	2.46 (0.67-9.06)	0.175
Weight loss (yes vs no)	1.14 (0.40-3.28)	0.810
Preoperative jaundice (yes vs no)	0.85 (0.29-2.49)	0.762
Preoperative acute pancreatitis (yes vs no)	3.87 (1.30-11.46)	0.015	4.70 (1.48-14.96)	0.009
Preoperative biliary drainage (yes vs no)	2.55 (0.65-10.1)	0.181
Comorbid disease (yes vs no)	2.78 (0.95-8.07)	0.061	3.72 (1.18-11.75)	0.025
Intraoperative blood transfusion (yes vs no)	2.92 (0.99-8.61)	0.052	3.50 (1.11-10.97)	0.032
Histology (pancreatic vs other)	0.74 (0.26-2.13)	0.578

¹Logistic regression. NS: Not significant.