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Early intraperitoneal metabolic changes and protease activation as indicators of pancreatic fistula after pancreaticoduodenectomy

Ansorge, C.; Regnér, Sara LU ; Segersvard, R. and Strommer, L. (2012) In British Journal of Surgery 99(1). p.104-111
Abstract
Background: Ischaemia and local protease activation close to the pancreaticojejunal anastomosis (PJA) are potential mechanisms of postoperative pancreatic fistula (POPF) formation. To provide information on the pathophysiology of POPF, intraperitoneal microdialysis was used to monitor metabolic changes and protease activation close to the PJA after pancreaticoduodenectomy (PD). Methods: In patients who underwent PD, intraperitoneal metabolites (glycerol, lactate, pyruvate and glucose) were measured by microdialysis, and lactate and glucose in blood were monitored, every 4 h for 5 days, starting at 12.00 hours on the day after surgery. Trypsinogen activation peptide (TAP) was measured in microdialysates as a marker of protease activation.... (More)
Background: Ischaemia and local protease activation close to the pancreaticojejunal anastomosis (PJA) are potential mechanisms of postoperative pancreatic fistula (POPF) formation. To provide information on the pathophysiology of POPF, intraperitoneal microdialysis was used to monitor metabolic changes and protease activation close to the PJA after pancreaticoduodenectomy (PD). Methods: In patients who underwent PD, intraperitoneal metabolites (glycerol, lactate, pyruvate and glucose) were measured by microdialysis, and lactate and glucose in blood were monitored, every 4 h for 5 days, starting at 12.00 hours on the day after surgery. Trypsinogen activation peptide (TAP) was measured in microdialysates as a marker of protease activation. Results: Intraperitoneal glycerol levels and the ratio of lactate to pyruvate were higher after PD and glucose levels were lower in seven patients who later developed symptomatic POPF than in eight patients with other surgical complications (OSC) and 33 with no surgical complications (NSC) (all P < 0.050). TAP was detected at a concentration greater than 0.1 mu g/l in six of seven patients with POPF, two of eight with OSC and two of 33 with NSC. Intraperitoneal lactate concentrations were higher than systemic levels in all patients on days 1 to 5 after surgery (P < 0.001). In patients with POPF, high intraperitoneal lactate concentrations were observed without systemic hyperlactataemia. Conclusion: Early in the postoperative phase, patients who later developed clinically significant POPF had higher intraperitoneal glycerol concentrations and lactate/pyruvate ratios, and lower glucose concentrations in combination with a TAP level exceeding 0.1 mu g/l close to the PJA, than patients who did not develop POPF. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
British Journal of Surgery
volume
99
issue
1
pages
104 - 111
publisher
John Wiley & Sons
external identifiers
  • wos:000303147800017
  • scopus:82955232378
ISSN
1365-2168
DOI
10.1002/bjs.7730
language
English
LU publication?
yes
id
e823dc29-4a48-4f1a-9d01-f1f4ab524e20 (old id 2570784)
date added to LUP
2012-06-01 08:52:01
date last changed
2017-08-13 03:20:18
@article{e823dc29-4a48-4f1a-9d01-f1f4ab524e20,
  abstract     = {Background: Ischaemia and local protease activation close to the pancreaticojejunal anastomosis (PJA) are potential mechanisms of postoperative pancreatic fistula (POPF) formation. To provide information on the pathophysiology of POPF, intraperitoneal microdialysis was used to monitor metabolic changes and protease activation close to the PJA after pancreaticoduodenectomy (PD). Methods: In patients who underwent PD, intraperitoneal metabolites (glycerol, lactate, pyruvate and glucose) were measured by microdialysis, and lactate and glucose in blood were monitored, every 4 h for 5 days, starting at 12.00 hours on the day after surgery. Trypsinogen activation peptide (TAP) was measured in microdialysates as a marker of protease activation. Results: Intraperitoneal glycerol levels and the ratio of lactate to pyruvate were higher after PD and glucose levels were lower in seven patients who later developed symptomatic POPF than in eight patients with other surgical complications (OSC) and 33 with no surgical complications (NSC) (all P &lt; 0.050). TAP was detected at a concentration greater than 0.1 mu g/l in six of seven patients with POPF, two of eight with OSC and two of 33 with NSC. Intraperitoneal lactate concentrations were higher than systemic levels in all patients on days 1 to 5 after surgery (P &lt; 0.001). In patients with POPF, high intraperitoneal lactate concentrations were observed without systemic hyperlactataemia. Conclusion: Early in the postoperative phase, patients who later developed clinically significant POPF had higher intraperitoneal glycerol concentrations and lactate/pyruvate ratios, and lower glucose concentrations in combination with a TAP level exceeding 0.1 mu g/l close to the PJA, than patients who did not develop POPF.},
  author       = {Ansorge, C. and Regnér, Sara and Segersvard, R. and Strommer, L.},
  issn         = {1365-2168},
  language     = {eng},
  number       = {1},
  pages        = {104--111},
  publisher    = {John Wiley & Sons},
  series       = {British Journal of Surgery},
  title        = {Early intraperitoneal metabolic changes and protease activation as indicators of pancreatic fistula after pancreaticoduodenectomy},
  url          = {http://dx.doi.org/10.1002/bjs.7730},
  volume       = {99},
  year         = {2012},
}