Background: Since its definition in 2022, postpancreatectomy acute pancreatitis has been increasingly recognized as a critical postoperative entity, but its clinical significance has not been evaluated through systematic review and meta-analysis. The aim of current study was to evaluate the clinical implications of postoperative hyperamylasemia and postpancreatectomy acute pancreatitis according to the International Study Group for Pancreatic Surgery consensus definition. Methods: A systematic review with meta-analysis was conducted in PubMed, EMBASE, and Cochrane Library databases. Studies published between January 2022 and August 2024 that used the International Study Group for Pancreatic Surgery definitions for postoperative hyperamylasemia and postpancreatectomy acute pancreatitis were included. Risk ratios with 95% confidence intervals were calculated using a Mantel-Haenszel random-effects model. Results: Eleven studies were included in the meta-analysis. Postoperative hyperamylasemia was associated with increased postoperative pancreatic fistula rates (risk ratio, 0.33; 95% confidence interval, 0.21–0.51; P < .001). Postpancreatectomy acute pancreatitis was associated with greater rates of postoperative pancreatic fistula (risk ratio, 0.24; 95% confidence interval, 0.17–0.35; P < .001), postoperative pancreatic hemorrhage (risk ratio, 0.39; 95% confidence interval, 0.26–0.59; P < .001), delayed gastric emptying (risk ratio, 0.57; 95% confidence interval, 0.41–0.79; P = .007), Clavien-Dindo classification IIIa or greater complications (risk ratio, 0.38; 95% confidence interval, 0.25–0.58; P < .001), mortality (risk ratio, 0.42; 95% confidence interval, 0.27–0.65; P = .001), and longer hospital stays (mean difference, −7.76 days; 95% confidence interval, −12.52 to 3.00; P = .001). Conclusion: This first meta-analysis exploring their clinical significance demonstrates that both postoperative hyperamylasemia and postpancreatectomy acute pancreatitis are associated with increased postoperative complications after pancreatectomy. The adoption of these definitions in clinical practice could significantly impact the postoperative course by early stratifying patients at higher risk for additional morbidity.
Clinical implications of postoperative hyperamylasemia and postpancreatectomy acute pancreatitis after pancreatectomy: A systematic review and meta-analysis
Cillo, Umberto;Perri, Giampaolo;Marchegiani, Giovanni
2025
Abstract
Background: Since its definition in 2022, postpancreatectomy acute pancreatitis has been increasingly recognized as a critical postoperative entity, but its clinical significance has not been evaluated through systematic review and meta-analysis. The aim of current study was to evaluate the clinical implications of postoperative hyperamylasemia and postpancreatectomy acute pancreatitis according to the International Study Group for Pancreatic Surgery consensus definition. Methods: A systematic review with meta-analysis was conducted in PubMed, EMBASE, and Cochrane Library databases. Studies published between January 2022 and August 2024 that used the International Study Group for Pancreatic Surgery definitions for postoperative hyperamylasemia and postpancreatectomy acute pancreatitis were included. Risk ratios with 95% confidence intervals were calculated using a Mantel-Haenszel random-effects model. Results: Eleven studies were included in the meta-analysis. Postoperative hyperamylasemia was associated with increased postoperative pancreatic fistula rates (risk ratio, 0.33; 95% confidence interval, 0.21–0.51; P < .001). Postpancreatectomy acute pancreatitis was associated with greater rates of postoperative pancreatic fistula (risk ratio, 0.24; 95% confidence interval, 0.17–0.35; P < .001), postoperative pancreatic hemorrhage (risk ratio, 0.39; 95% confidence interval, 0.26–0.59; P < .001), delayed gastric emptying (risk ratio, 0.57; 95% confidence interval, 0.41–0.79; P = .007), Clavien-Dindo classification IIIa or greater complications (risk ratio, 0.38; 95% confidence interval, 0.25–0.58; P < .001), mortality (risk ratio, 0.42; 95% confidence interval, 0.27–0.65; P = .001), and longer hospital stays (mean difference, −7.76 days; 95% confidence interval, −12.52 to 3.00; P = .001). Conclusion: This first meta-analysis exploring their clinical significance demonstrates that both postoperative hyperamylasemia and postpancreatectomy acute pancreatitis are associated with increased postoperative complications after pancreatectomy. The adoption of these definitions in clinical practice could significantly impact the postoperative course by early stratifying patients at higher risk for additional morbidity.
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