New findings of postoperative acute pancreatitis after distal pancreatectomy.

Background: The definition of postoperative acute pancreatitis (POAP) was proposed in 2016 as a specific complication of pancreatic surgery. It’s known that POAP after pancreaticoduodenectomy correlated with high incidence of severe complications including POPF. However, the significance of POAP after distal pancreatectomy (DP) has not been investigated. The aim of this study is to elucidate the clinical significance of POAP after DP.Methods: Medical records of 166 patients who underwent DP at our university were analyzed. POAP was defined as an elevation in serum amylase above the upper limit of normal (≧ 133 U/L) on postoperative day (POD) one based on the Connor’s criteria. The correlation of POAP with postoperative outcomes and risk factors of POAP after DP were investigated.Results: POAP occurred in 65.7% of DP. POAP occurrence after DP was not correlated with levels of drain amylase on POD one and POD three. Patients who developed POAP after DP experienced a similar postoperative course regarding morbidity, mortality, and the length of postoperative stay. On the other hand, POAP in association with a C-reactive protein (CRP) elevation ≧18.0 mg/dl (clinically relevant- POAP) after DP was associated with higher incidence of Clavien-Dindo ≧ IIIA (P=0.0067), POPF (P=0.0307) and abdominal abscesses (P=0.0077) although the length of postoperative stay was not affected (P=0.1467). Blood loss ≧ 350 ml was an independent risk factor of POAP.Conclusions: POAP after DP does not affect clinical coarse. Clinically relevant- POAP has a potential to sort out the patients who will develop POPF even after DP.