| Title: |
Early and Sustained Elevation in Serum Pancreatic Amylase Activity: A Novel Predictor of Morbidity After Pancreatic Surgery |
| Authors: |
Bannone, Elisa; Marchegiani, Giovanni; Balduzzi, Alberto; Procida, Giuseppa; Vacca, Pier Giuseppe; Salvia, Roberto; Bassi, Claudio |
| Contributors: |
Bannone, Elisa; Marchegiani, Giovanni; Balduzzi, Alberto; Procida, Giuseppa; Vacca, Pier Giuseppe; Salvia, Roberto; Bassi, Claudio |
| Publication Year: |
2023 |
| Collection: |
Università degli Studi di Verona: Catalogo dei Prodotti della Ricerca (IRIS) |
| Subject Terms: |
postoperative hyperamylasemia; postpancreatectomy acute pancreatitis; serum amylase trend |
| Description: |
Objective:To characterize early postoperative serum pancreatic amylase (spAMY) trends after pancreatic resections. Summary Background Data:A postoperative spAMY elevation is a common finding but uncertainties remain about its meaning and prognostic implications. Methods:Analysis of patients who consecutively underwent pancreatectomy from 2016 to 2019. spAMY activity was assessed from postoperative day (POD) 0 to 3. Different patterns of spAMY have been identified based on the spAMY standard range (10-52 U/l). Results:Three patterns were identified: (#1) spAMY values always < the lower limit of normal/within the reference range /a single increase in spAMY > upper limit of normal at any POD; (#2) Sustained increase in spAMY activity on POD 0 + 1; (#3) Sustained increase in spAMY activity including POD 1 + 2. Shifting through spAMY patterns was associated with increase morbidity (21% in #1 to 68% in #3 at POD 7; log rank < 0.001). Almost all severe complications (at least Clavien-Dindo >= 3) occurred in patients with pattern #3 (15% vs 3% vs 5% in #1 and #2 at POD 7, P = 0.006), without difference considering >3-times or >the spAMY normal limit (P = 0.85). POPF (9% in #1 vs 48% in #3, P < 0.001) progressively increased across patterns. Pre-operative diabetes (OR 0.19), neoadjuvant therapy (OR 0.22), pancreatic texture (OR 8.8), duct size (OR 0.78), and final histology (OR 2.2) were independent predictors of pattern #3. Conclusions:A sustained increase in spAMY activity including POD 1 + 2 (#3) represents an early postoperative predictor of overall and severe early morbidity. An early and dynamic evaluation of spAMY could crucially impact the subsequent clinical course with relevant prognostic implications. |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| Relation: |
info:eu-repo/semantics/altIdentifier/pmid/33938491; info:eu-repo/semantics/altIdentifier/wos/WOS:000905219700038; volume:277; issue:1; firstpage:N/A; lastpage:N/A; numberofpages:N/A; journal:ANNALS OF SURGERY; https://hdl.handle.net/11562/1108947 |
| DOI: |
10.1097/SLA.0000000000004921 |
| Availability: |
https://hdl.handle.net/11562/1108947; https://doi.org/10.1097/SLA.0000000000004921 |
| Rights: |
info:eu-repo/semantics/openAccess ; license:Dominio pubblico ; license uri:http://creativecommons.org/publicdomain/zero/1.0/ |
| Accession Number: |
edsbas.CF06C2E2 |
| Database: |
BASE |