Predicting the severity of postoperative pancreatitis and postoperative pancreatic fistulae following major pancreatic resection
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Open Access
Type
ThesisThesis type
Masters by ResearchAuthor/s
Chui, JuanitaAbstract
Postoperative pancreatic fistula (POPF) represents the leading cause of morbidity and mortality following partial pancreatectomy. Emerging evidence has challenged the traditional understanding of POPF and redefined its relationship to postoperative pancreatitis. The aim of this ...
See morePostoperative pancreatic fistula (POPF) represents the leading cause of morbidity and mortality following partial pancreatectomy. Emerging evidence has challenged the traditional understanding of POPF and redefined its relationship to postoperative pancreatitis. The aim of this thesis was to synthesize the recent evidence, characterise the risk factors for postoperative pancreatitis and POPF, and to identify a prognostic indicator to facilitate the risk stratification of patients undergoing major pancreatic resection. Firstly, we evaluate established risk factors, including parameters that comprise the Fistula Risk Score. We then evaluate the utility of pancreatic enzyme concentrations in postoperative drain fluid to predict for clinically relevant fistulae. From these results, we propose lipase-to-amylase ratio as a novel predictor for clinically relevant POPF and demonstrate its correlation with acinar cell density at the pancreatic resection margin. Post-pancreatectomy acute pancreatitis (PPAP) has recently been recognized as a distinct postoperative complication. The second part of this thesis presents a validation study for the 2021 International Study Group on Pancreatic Surgery (ISGPS) consensus criteria for diagnosis and grading of PPAP. Our results support the utility of a universally accepted definition and the need for future studies to better characterise PPAP as a clinical entity. This work highlights key areas warranting further research and provides important insights into PPAP and POPF pathophysiology that should interest future investigators. Our findings lend further evidence to the importance of acinar cell density as an intrinsic risk factor, the role of PPAP in driving POPF pathogenesis, and the mechanisms of iatrogenic acinar cell injury that represent new targets for risk mitigation strategies.
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See morePostoperative pancreatic fistula (POPF) represents the leading cause of morbidity and mortality following partial pancreatectomy. Emerging evidence has challenged the traditional understanding of POPF and redefined its relationship to postoperative pancreatitis. The aim of this thesis was to synthesize the recent evidence, characterise the risk factors for postoperative pancreatitis and POPF, and to identify a prognostic indicator to facilitate the risk stratification of patients undergoing major pancreatic resection. Firstly, we evaluate established risk factors, including parameters that comprise the Fistula Risk Score. We then evaluate the utility of pancreatic enzyme concentrations in postoperative drain fluid to predict for clinically relevant fistulae. From these results, we propose lipase-to-amylase ratio as a novel predictor for clinically relevant POPF and demonstrate its correlation with acinar cell density at the pancreatic resection margin. Post-pancreatectomy acute pancreatitis (PPAP) has recently been recognized as a distinct postoperative complication. The second part of this thesis presents a validation study for the 2021 International Study Group on Pancreatic Surgery (ISGPS) consensus criteria for diagnosis and grading of PPAP. Our results support the utility of a universally accepted definition and the need for future studies to better characterise PPAP as a clinical entity. This work highlights key areas warranting further research and provides important insights into PPAP and POPF pathophysiology that should interest future investigators. Our findings lend further evidence to the importance of acinar cell density as an intrinsic risk factor, the role of PPAP in driving POPF pathogenesis, and the mechanisms of iatrogenic acinar cell injury that represent new targets for risk mitigation strategies.
See less
Date
2022Rights statement
The author retains copyright of this thesis. It may only be used for the purposes of research and study. It must not be used for any other purposes and may not be transmitted or shared with others without prior permission.Faculty/School
Faculty of Medicine and Health, Northern Clinical SchoolAwarding institution
The University of SydneyShare