Predictors of Postoperative Pancreatic Fistula (POPF) After Pancreaticoduodenectomy: Clinical Significance of the Mean Platelet Volume (MPV)/Platelet Count Ratio as a New Predictor.

Autor: Lale A; Department of Surgical Oncology, Faculty of Medicine, Fırat University Medical Faculty Hospital, Elazig, 23200, Turkey. dr.azmilale@hotmail.com., Kirmizi I; Department of Gastrointestinal Surgery, Aydin State Hospital, Aydin, Turkey., Hark BD; Department of Biostatistics and Medical Informatics, School of Medicine, Firat University, Elazig, Turkey., Karahan V; Department of Surgical Oncology, Faculty of Medicine, Fırat University Medical Faculty Hospital, Elazig, 23200, Turkey., Kurt R; Department of Surgical Oncology, Faculty of Medicine, Fırat University Medical Faculty Hospital, Elazig, 23200, Turkey., Arikan TB; Department of General Surgery, Erciyes University Medical Faculty Hospital, Kayseri, Turkey., Yıldırım N; Department of Medical Oncology, Fırat University Medical Faculty Hospital, Elazig, Turkey., Aygen E; Department of Surgical Oncology, Faculty of Medicine, Fırat University Medical Faculty Hospital, Elazig, 23200, Turkey.
Jazyk: angličtina
Zdroj: Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract [J Gastrointest Surg] 2022 Feb; Vol. 26 (2), pp. 387-397. Date of Electronic Publication: 2021 Sep 20.
DOI: 10.1007/s11605-021-05136-5
Abstrakt: Purpose: In this study, it was aimed to determine the predictors of clinically relevant postoperative pancreatic fistula (CR-POPF) following pancreaticoduodenectomy (PD) and clinical significance of mean platelet volume (MPV)/total platelet count ratio (MPR) as a new predictor for CR-POPF.
Methods: A total of 105 patients who underwent PD consecutively due to periampullary located diseases were included in the study. Patients were divided into two groups as CR-POPF and no postoperative pancreatic fistula (No-POPF). Demographic parameters, preoperative serum-based inflammatory indicators, surgical procedures, intraoperative findings, and histopathological parameters were recorded retrospectively from prospectively recorded patient files and compared between the groups.
Results: CR-POPF occurred in 16 (15.2%) patients: 8 (7.6%) were grade B and 8 (7.6%) were grade C according to the ISGPF classification. In univariate analysis, intraoperative blood loss > 580 mL (OR: 5.25, p = 0.001), intraoperative blood transfusion (OR: 5.96, p = 0.002), intraoperative vasoconstrictor medication (OR: 4.17, p = 0.014), benign histopathology (OR: 3.51, p = 0.036), and poor differentiation in malignant tumors (OR: 4.07, p = 0.044) were significantly higher in the CR-POPF group, but not significant in multivariate analysis. Soft pancreatic consistency (OR: 6.08, p = 0.013), pancreatic duct diameter < 2.5 mm (OR: 17.15, p < 0.001), and MPR < 28.9 (OR: 13.91, p < 0.001) were the independent predictors of CR-POPF according to multivariate analysis. Neoadjuvant treatment history and simultaneous vascular resection were less likely to cause CR-POPF development; however, they were insignificant.
Conclusion: Soft pancreatic consistency, pancreatic duct diameter, and preoperative MPR were the independent predictors of CR-POPF following PD. Decreased MPR is a strong predictor for CR-POPF and should be considered when deciding treatment strategies.
(© 2021. The Society for Surgery of the Alimentary Tract.)
Databáze: MEDLINE
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