Preoperative acute pancreatitis in periampullary tumors: Implications for surgical management

Background: Pancreatitis is the most serious complication of endoscopic retrograde cholangiopancreatography (ERCP), occurring in 2-20% of the patients. Currently there is no information about the impact of preoperative pancreatitis on the surgical management of periampullary tumors. Methods: Ten patients with periampullary tumors and preoperative acute pancreatitis were retrospectively analyzed. Four patients who underwent pylorus-preserving pancreaticoduodenectomy (group A) and 6 patients who underwent total pancreatectomy (group B) were compared with a matching control group (age, gender, stage, tumor and operation type) of 30 patients without pancreatitis (group C) who underwent an operation during the same period. Parameters analyzed were C-reactive protein (CRP), leukocytes, aminotransferases, amylase, lipase, operative time, blood loss, hospital stay, morbidity, and mortality. Results: In the study group, 5 patients had pancreatic adenocarcinoma, 3 had distal bile duct cancers, and 2 had ampullary tumors. None of the patients had severe acute necrotizing pancreatitis that necessitated intervention prior to tumor resection. Preoperative median CRP levels in group B were 8.4- and 5.6-fold higher than those of groups A and C, respectively. In contrast, leukocytes, aminotransferases, amylase, and lipase levels were not significantly different. The presence of acute pancreatitis slightly prolonged the duration of the operation (+15 min), increased morbidity (60 vs. 33%) and lengthened median hospital stay (19.5 vs. 14.5 days) in groups A and B vs. group C. All patients with preoperative pancreatitis were managed without mortality. Conclusion: Preoperative pancreatitis is more commonly seen in patients with non-pancreatic periampullary tumors, and considerably influences surgical management. High preoperative CRP levels indicate a more severe form of pancreatic damage that may necessitate a total pancreatectomy.