The value of drain fluid amylase as a predictor of postoperative pancreatic fistula after pancreaticogastrostomy

Purpose Postoperative pancreatic fistula (POPF) with reported incidence rates up to 45% contributes substantially to overall morbidity. In this study, we conducted a retrospective evaluation of POPF along with its potential perioperative clinical risk factors and its effect on tumor recurrence. Methods Clinical data on patients who had received pancreatoduodenectomy (PD), distal pancreatectomy (DP), or duodenum-preserving pancreatic head resection (DPPHR) were prospectively collected between 2007 and 2016. A Picrosirius red staining score was developed to enable morphological classification of the resection margin of the pancreatic stump. The primary end point was the development of major complications. The secondary end points were overall and recurrence-free survival. Results 340 patients underwent pancreatic resection including 222 (65.3%) PD, 87 (25.6%) DP, and 31 (9.1%) DPPHR. Postoperative major complications were observed in 74 patients (21.8%). In multivariable logistic regression analysis, POPF correlated with body mass index (BMI) (p = 0.025), prolonged stay in hospital (p<0.001), high Picrosirius red staining score (p = 0.049), and elevated postoperative levels of amylase or lipase in drain fluid (p≤0.001). Multivariable Cox regression analysis identified UICC stage (p<0.001), tumor differentiation (p<0.001), depth of invasion (p = 0.001), nodal invasion (p = 0.001), and the incidence of POPF grades B and C (p = 0.006) as independent prognostic markers of recurrence-free survival. Conclusion Besides the known clinicopathological risk factors BMI and amylase in the drain fluid, the incidence of POPF correlates with high Picrosirius red staining score in the resection margins of the pancreatic stumps of curatively resected pancreatic ductal adenocarcinoma (PDAC). Furthermore, clinically relevant POPF seems to be a prognostic factor for tumor recurrence in PDAC.

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Early Drain Removal Regardless of Drain Fluid Amylase Level Might Reduce Risk of Postoperative Pancreatic Fistula

Anticancer Research ◽

10.21873/anticanres.14789 ◽

2021 ◽

Vol 41 (1) ◽

pp. 403-408

Author(s):

HIROMICHI KAWAIDA ◽

HIROSHI KONO ◽

HIDETAKE AMEMIYA ◽

NAOHIRO HOSOMURA ◽

YUDAI HIGUCHI ◽

...

Keyword(s):

Pancreatic Fistula ◽

Postoperative Pancreatic Fistula ◽

Amylase Level ◽

Drain Removal ◽

Drain Fluid ◽

Reduce Risk

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Drain fluid amylase in defining clinically relevant postoperative pancreatic fistula following pancreaticoduodenectomy: day 5 is better than day 3

International Surgery Journal ◽

10.18203/2349-2902.isj20175410 ◽

2017 ◽

Vol 4 (12) ◽

pp. 4058

Author(s):

Venkatarami Reddy Vutukuru ◽

Sivarama Krishna Gavini ◽

Chandramaliteeswaran C. ◽

Dinakar Reddy A. ◽

Varun Dasari ◽

...

Keyword(s):

Prospective Study ◽

Hospital Stay ◽

Pancreatic Fistula ◽

Postoperative Pancreatic Fistula ◽

P Value ◽

Duration Of Hospital Stay ◽

Drain Fluid ◽

Group A ◽

Group B ◽

Better Than

Background: Postoperative pancreatic fistula (POPF) remains the most serious complication of Pancreaticoduodenectomy. ISGPF defined POPF in 2005 based on drain fluid amylase on or after day 3 and graded the severity. But as Grade A fistulas are not clinically relevant, most of the clinicians do not consider them as POPF. Hence exact incidence of POPF is not known. Our aim is to see weather drain fluid amylase on or after day 5 can define clinically relevant POPF better than day 3.Methods: Prospective study included all patients who underwent Pancreaticoduodenectomy during the period January 2013 to November 2016. Serum and Drain fluid amylase were analyzed on Day 3. Those who met criteria of POPF underwent repeat amylase on Day 5. These patients were divided into 2 groups. Group A includes patients whose Day 5 amylase normalized and Group B where elevated Amylase persisted. Outcomes were compared in 2 Groups in terms of clinically relevant POPF (CRF), DGE, Haemorrhage (PPH), hospital stay and 30 Days mortality. Results were analysed and p value <0.05 was considered significant.Results: On 110 patients, 44 (40%) met ISGPF criteria of POPF. Of 44, 36 (82%) had normalized Amylase on Day 5 (Group A). Only 8 (18%) had persistent elevated amylase (Group B). None in Group A had CRF, whereas in Group B, 6(75%) had CRF and 2(25%) had only biochemical leak (p<0.0001). DGE was significantly higher in Group B (87.5% vs. 33.3%; p=0.013). PPH was seen in only 1 patient (Group A). Duration of hospital stay and 30day mortality were similar.Conclusions: Drain fluid amylase levels on or after Day 5 defines clinically relevant POPF better than levels on or after day 3.

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EARLY DRAIN FLUID AMYLASE IS USEFUL TO PREDICT PANCREATIC FISTULA AFTER PANCREATODUODENECTOMY: LESSONS LEARNED FROM A SOUTHERN BRAZILIAN CENTER

Arquivos de Gastroenterologia ◽

10.1590/s0004-2803.201800000-28 ◽

2018 ◽

Vol 55 (2) ◽

pp. 160-163 ◽

Cited By ~ 2

Author(s):

Uirá Fernandes TEIXEIRA ◽

Pablo Duarte RODRIGUES ◽

Marcos Bertozzi GOLDONI ◽

José Artur SAMPAIO ◽

Paulo Roberto Ott FONTES ◽

...

Keyword(s):

Pancreatic Fistula ◽

Early Stage ◽

Postoperative Pancreatic Fistula ◽

Lessons Learned ◽

High Morbidity ◽

Patients At Risk ◽

Drain Fluid ◽

Group 3 ◽

Group 2 ◽

Group 1

ABSTRACT BACKGROUND: Pancreatic fistula represents the most feared complication after pancreatoduodenectomies, being the major responsible for the high morbidity and mortality after this operation. Its incidence remains around 10% to 30%. In recent years, several authors have studied the value of amylase in abdominal drains fluid, measured at an early stage after the surgical procedure, as a useful tool to identify patients at risk of developing pancreatic fistula. OBJECTIVE: To analyze the value of early drain fluid amylase as a method to predict the occurrence and severity of postoperative pancreatic fistula in patients undergoing pancreatoduodenectomies. METHODS: We evaluated 102 prospective patients submitted to pancreatoduodenectomies from January 2013 to June 2017. The mensuration of amylase in abdominal drains was performed on days 1, 3, 5 and 7 in all patients. Patients were divided into three groups according to postoperative day 1 (POD1) results: values <270 U/L (group 1); between 271 and 5.000 U/L (group 2); and values >5.000 U/L (group 3). RESULTS: The incidence of pancreatic fistula was 25.5%, being 3.33%, 27.3% and 41.02% in the three groups, respectively. Compared with group 1, the risk of developing pancreatic fistula increased with increasing amylase values on POD1. Amylase values on POD1 and POD3 of patients with pancreatic fistula were higher than in the other ones without this complication (P<0.001). In addition, in group 3, 37.5% of patients with pancreatic fistula evolved to death (P<0.001). Finally, in this group, patients who died had drain fluid amylase values on POD1 significantly higher than the others in the same group (P<0.001). CONCLUSION: Early drain fluid amylase value is a useful test to stratify patients in relation to the risk of developing pancreatic fistula after pancreatoduodenectomies, in addition to correlate with the severity of this complication.

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Drain fluid amylase and lipase as a predictive factor of postoperative pancreatic fistula

ANZ Journal of Surgery ◽

10.1111/ans.17296 ◽

2021 ◽

Author(s):

Sharnice Koek ◽

Sophie Wiegele ◽

Mohammed Ballal

Keyword(s):

Pancreatic Fistula ◽

Predictive Factor ◽

Postoperative Pancreatic Fistula ◽

Drain Fluid

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Alternative Fistula Risk Score and First Postoperative Day Drain Fluid Amylase as Predictors of Pancreatic Fistula After Pancreatoduodenectomy

10.21203/rs.3.rs-726054/v1 ◽

2021 ◽

Author(s):

Karina Scalabrin Longo ◽

Thiago Bassaneze ◽

Rogério Tadeu Palma ◽

Jaques Waisberg

Keyword(s):

Pancreatic Fistula ◽

Risk Score ◽

Retrospective Cohort ◽

Predictive Power ◽

Confusion Matrix ◽

Postoperative Pancreatic Fistula ◽

Operating Characteristics ◽

Combined Model ◽

Drain Fluid ◽

Fistula Risk Score

Abstract Objectives: The alternative fistula risk score (aFRS) and the first postoperative day drain fluid amylase (DFA) are predictors of the occurrence of clinically relevant postoperative pancreatic fistula (CR-POPF). No consensus has been reached on which of the scores is a better predictor; moreover, their combined predictive power remains unclear. To our knowledge, this association had not yet been studied.Methods: This study assessed the predictive effect of aFRS and/or DFA on CR-POPF in a retrospective cohort of 58 patients following PD. The Shapiro-Wilk and the Mann-Whitney tests were applied for assessing the distribution of the samples and for comparing the medians, respectively. The receiver operating characteristics (ROC) curve and the confusion matrix were used to analyze the predictive models.Results: The aFRS values were not statistically different between patients in the CR-POPF and non-CR-POPF groups (Mann-Whitney U test: 59.5, p=0.12). The DFA values were statistically different between the CR-POPF and non-CR-POPF groups (Mann-Whitney U test: 27, p=0.004). The aFRS and DFA were independently less predictive for CR-POPF, compared to combined aFRS + DFA.Conclusions: The combined model involving aFRS>20% + DFA≥5,000 U/L was the most effective predictor of CR-POPF occurrence following PD.

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The value of serum amylase and drain fluid amylase to predict postoperative pancreatic fistula after pancreatoduodenectomy: a retrospective cohort study

Langenbeck s Archives of Surgery ◽

10.1007/s00423-021-02192-y ◽

2021 ◽

Author(s):

Jelle C. van Dongen ◽

Steven Merkens ◽

M. Hossein Aziz ◽

Bas Groot Koerkamp ◽

Casper H. J. van Eijck

Keyword(s):

Cohort Study ◽

Pancreatic Fistula ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Serum Amylase ◽

Predictive Accuracy ◽

Postoperative Pancreatic Fistula ◽

Postoperative Serum ◽

Drain Fluid ◽

Drain Amylase

Abstract Purpose Serum and drain amylase have been identified as important predictors of postoperative pancreatic fistula (POPF) and might be useful to guide postoperative drain management after pancreatoduodenectomy. We aimed to determine and compare the value of serum amylase and drain fluid amylase to predict postoperative pancreatic fistula after pancreatoduodenectomy. Methods This retrospective cohort study included patients after pancreatoduodenectomy from 2012 to 2019. The primary endpoint of our study was grade B/C POPF. Serum amylase on postoperative day 1 (SA-1) and drain fluid amylase on postoperative day 2 (DFA-2) were analyzed. Results A total of 92 of 437 patients (21.1%) developed a grade B/C POPF. SA-1 was higher in patients who developed a grade B/C POPF (336 U/L vs. 97 U/L, p<0.001). Similarly, DFA-2 was higher in patients who developed a grade B/C POPF (1764 U/L vs. 78 U/L, p<0.001). SA-1 and DFA-2 had similar predictive accuracy (AUC: 0.82 vs. 0.85, respectively, p=0.329). Patients with SA-1<100 U/L (n=178) had a risk of 2.2% of developing grade B/C POPF, compared to 38.2% in patients with SA-1 >100 U/L (n=207). Patients with DFA-2<100 U/L (n=141) had a risk of 0% of developing grade B/C POPF, compared to 36.2% in patients with DFA-2>100 U/L (n=196). SA-1 and DFA-2 were strongly associated at a cut-off of 100 U/L (p<0.001, 89% concordance rate). Conclusion Postoperative serum and drain amylase values below 100 U/L both effectively rule out POPF after pancreatoduodenectomy. The advantage of serum amylase measurement is that it can be used in patients who are managed without surgical drains.

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Neck Division Level and Postoperative Pancreatic Fistula After Pancreaticoduodenectomy

Case Medical Research ◽

10.31525/ct1-nct03850236 ◽

2019 ◽

Author(s):

Keyword(s):

Pancreatic Fistula ◽

Postoperative Pancreatic Fistula

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Non-operative Risk Factors and the Implications of Sandostatin for Postoperative Pancreatic Fistula in Malignant Pancreatic Surgery

Revista de Chimie ◽

10.37358/rc.17.12.5997 ◽

2018 ◽

Vol 68 (12) ◽

pp. 2875-2878

Author(s):

Delia Rusu Andriesi ◽

Ana Maria Trofin ◽

Irene Alexandra Cianga Spiridon ◽

Corina Lupascu Ursulescu ◽

Cristian Lupascu

Keyword(s):

Risk Factors ◽

Pancreatic Fistula ◽

Pancreatic Surgery ◽

Postoperative Pancreatic Fistula ◽

University Center ◽

Preoperative Hemoglobin ◽

Term Administration ◽

Postoperative Administration

Pancreatic fistula is the most frecquent and severe postoperative complication after pancreatic surgery, with impressive implications for the quality of life and vital prognosis of the patient and for these reasons it is essential to identify risk factors. In the current study, who included 109 patient admitted to a single university center and who underwent pancreatic resection for malignant pathology, we assessed the following factors as risk factors: age, sex, preoperative hemoglobin value, preoperative total protein value, obesity and postoperative administration of sandostatin. Of the analyzed factors, it appears that only obesity and long-term administration of sandostatin influences the occurrence of pancreatic fistula.

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