Ann Hepatobiliary Pancreat Surg.  2021 May;25(2):242-250. 10.14701/ahbps.2021.25.2.242.

Lymphopenia following pancreaticoduodenectomy is associated with pancreatic fistula formation

• Cohen JT
• Charpentier KP
• Miner TJ
• Cioffi WG
• Beard RE

• KMID: 2516245
• DOI: http://doi.org/10.14701/ahbps.2021.25.2.242

Abstract

Backgrounds/Aims
Post-operative pancreatic fistulas (POPF) are a major source of morbidity following pancreaticoduodenectomy (PD). This study aims to investigate if persistent lymphopenia, a known marker of sepsis, can act as an additional marker of POPF with clinical implications that could help direct drain management.
Methods
A retrospective chart review of all patients who underwent PD in a single hospital network from 2008 to 2018. Persistent lymphopenia was defined as lymphopenia beyond post-operative day #3.
Results
Of the 201 patients who underwent PD during the study period 161 patients had relevant laboratory data, 81 of whom had persistent lymphopenia. 17 patients with persistent lymphopenia went on to develop a POPF, compared to 7 patients without. Persistent lymphopenia had a negative predictive value of 91.3%. Multivariate analysis revealed only persistent lymphopenia as being independently associated with POPF (HR 2.57, 95% CI 1.07-6.643, p=0.039). Patients with persistent lymphopenia were more likely to have a complication requiring intervention (56.8% vs 35.0%, p＜0.001).
Conclusions
Persistent lymphopenia is a readily available early marker of POPF that holds the potential to identify clinically relevant POPF in patients where no surgical drain is present, and to act as an adjunct of drain amylase helping to guide drain management.

Keyword

Lymphopenia; Post-operative pancreatic fistula; Pancreaticoduodenectomy

Figure

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  Fig. 1 Flow chart of pancreatic leak patterns with sensitivity, specificity, positive predictive value and negative predicted value calculated.

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  Fig. 2 Kaplan Meier analysis of (A) overall survival and (B) Progression free survival of pancreatic ductal adenocarcinoma by lymphopenia status.

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