A new marker in post-pancreatectomy fistulas; hypophosphatemia

Yıl 2023, , 550 - 556, 30.09.2023

Özhan Çetindağ , Ali Ekrem Ünal

https://doi.org/10.18663/tjcl.1346797

Öz

Aim: Postoperative hypophosphatemia is associated with morbidity after many gastrointestinal surgeries. In this study,
we aimed to investigate the relationship between hypophosphatemia and POPF, which is one of the morbidities after pancreatectomy.
Material and Methods: All adult patients who underwent pancreatectomy in our surgical oncology clinic from 2010 to 2020 were included in the patient data recording system to the Faculty of Medicine of Ankara University, Surgical Oncology clinic. Exclusions were made for those under 18, without postoperative Jackson-Pratt (jp) amylase levels, and with previous pancreatic surgery.
Results: Examination of a total of 185 patients showed that fistula occurred in 20% of cases. Statistical analysis revealed that postoperative 2nd and 3rd-day phosphorus levels are markers for pancreatic leak.
Conclusion: Decreased phosphate values after pancreatic surgery may be an indicator for pancreatic fistula, especially significant on the 2nd and 3rd postoperative days

Anahtar Kelimeler

Pancreatectomy, Postoperative Fistula, Hypophosphatemia, Surgical Oncology, Pancreatic Leak, Phosphorus Levels

Post-pankreatektomi fistüllerinde yeni bir belirteç; hipofosfatemi

Öz

Amaç: Postoperatif hipofosfatemi, birçok gastrointestinal cerrahi sonrası morbidite ile ilişkilidir. Bu çalışmada, hipofosfatemi ile pankreatektomi sonrası morbiditelerden biri olan POPF arasındaki ilişkiyi araştırmayı amaçladık.
Gereç ve Yöntemler: 2010 ile 2020 yılları arasında cerrahi onkoloji kliniğimizde pankreatektomi uygulanan tüm yetişkin hastalar, Ankara Üniversitesi Tıp Fakültesi, Cerrahi Onkoloji Kliniği hastaların veri kayıt sistemine dahil edildi. 18 yaşından küçük hastalar, postoperatif Jackson-Pratt (jp) amilaz seviyesi olmayan hastalar ve önceki pankreas cerrahisi olan hastalar bu çalışma dışı bırakıldı. Bulgular: Toplam 185 hastanın takibinde fistül gelişip gelişmediği kaydedildi ve vakaların %20'sinde fistül meydana geldi. Fistül ile BMI, yaş, cinsiyet, ca-19.9 seviyeleri ve ameliyat öncesi fosfor seviyeleri, pankreas cerrahisi türü ve ameliyat sonrası günlerdeki 0-1-2-3 fosfor seviyeleri arasındaki ilişki incelendi. POPF olmayan ve olan grup arasında POPL 0 değerleri arasında istatistiksel olarak anlamlı bir fark bulunmadı (p=0.422). POPF olmayan ve olan gruplardaki POPL 1 değerlerindeki fark önemli değil (p=0.296). POPF olmayan ve olan gruplardaki POPL 2 değerlerindeki fark anlamlı (p=0.002). POPF olmayan ve olan grup arasında POPL 3 değerlerindeki fark anlamlıydı (p=0.001). İstatistiksel analiz, ameliyat sonrası 0. gün fosfor seviyeleri ve ameliyat sonrası 1. gün fosfor seviyelerinin pankreas kaçağının bir göstergesi olmadığını, ameliyat sonrası 2. ve 3. gün fosfor seviyelerinin ise çalışma grubumuzda pankreas kaçağının belirleyicisi olduğunu gösterdi.
Sonuç: Pankreas cerrahisi sonrası azalan fosfat değerleri, pankreatik fistül için bir gösterge olabilir. Fosfor seviyeleri, özellikle ameliyat sonrası 2. ve 3. günlerde kaçak açısından anlamlı bulundu.

Anahtar Kelimeler

Pankreatektomi, Postoperatif Fistül, Hipofosfatemi, Cerrahi Onkoloji, Pankreatik Sızıntı, Fosfor Seviyeleri

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