Ann Hepatobiliary Pancreat Surg.  2018 Nov;22(4):397-404. 10.14701/ahbps.2018.22.4.397.

Predictive value of post-operative drain amylase levels for post-operative pancreatic fistula

Affiliations
  • 1Department of General Surgery, Tan Tock Seng Hospital, Singapore. tangserene@gmail.com

Abstract

BACKGROUNDS/AIMS
Traditionally, surgically placed pancreatic drains are removed, at the discretion of the operating surgeon. Moving towards enhanced recovery after surgery (ERAS), we looked for predictors for early drain removal. The purpose of this paper was to establish which postoperative days' (POD) drain amylase is most predictive against post-operative pancreatic fistula (POPF).
METHODS
We conducted a retrospective study of 196 patients who underwent pancreatic resection at our institute from January 2006 to October 2013. Drain amylase levels were routinely measured. The International Study Group of Pancreatic Fistula (ISGPF) definition of POPF, and clinical severity grading were used.
RESULTS
5.1% (10 of 196) patients developed ISGPF Grades B and C POPF. Negative predictive value of developing significant POPF, if drain amylase values were low on PODs 1 and 3 was 98.7% (95% CI: 0.93-1.00). This translated to confidence in removing surgically placed pancreatic drains, at POD 1 and 3 when drain amylase values are low.
CONCLUSIONS
Patients with low drain amylase values on POD 1 and 3, are unlikely to develop POPF and may have pancreatic drains removed earlier.

Keyword

Pancreatic fistula; Pancreatoduodenectomy; Distal pancreatectomy; Enhanced recovery after surgery

MeSH Terms

Amylases*
Humans
Pancreatic Fistula*
Pancreaticoduodenectomy
Retrospective Studies
Amylases

Cited by  1 articles

Lymphopenia following pancreaticoduodenectomy is associated with pancreatic fistula formation
Joshua T. Cohen, Kevin P. Charpentier, Thomas J. Miner, William G. Cioffi, Rachel E. Beard
Ann Hepatobiliary Pancreat Surg. 2021;25(2):242-250.    doi: 10.14701/ahbps.2021.25.2.242.


Reference

1. Machado NO. Pancreatic fistula after pancreatectomy: definitions, risk factors, preventive measures, and management—review. Int J Surg Oncol. 2012; 2012:602478.
2. Pratt WB, Maithel SK, Vanounou T, Huang ZS, Callery MP, Vollmer CM Jr. Clinical and economic validation of the International Study Group of Pancreatic Fistula (ISGPF) classification scheme. Ann Surg. 2007; 245:443–451.
Article
3. Schmidt CM, Powell ES, Yiannoutsos CT, Howard TJ, Wiebke EA, Wiesenauer CA, et al. Pancreaticoduodenectomy: a 20-year experience in 516 patients. Arch Surg. 2004; 139:718–725. discussion 725-727.
4. Schäfer M, Müllhaupt B, Clavien PA. Evidence-based pancreatic head resection for pancreatic cancer and chronic pancreatitis. Ann Surg. 2002; 236:137–148.
Article
5. Zhou Y, Zhang X, Wu L, Ye F, Su X, Li B. Evidence-based value of prophylactic intraperitoneal drainage following pancreatic resection: a meta- analysis. Pancreatology. 2014; 14:302–307.
6. McMillan MT, Malleo G, Bassi C, Sprys MH, Vollmer CM Jr. Defining the practice of pancreatoduodenectomy around the world. HPB (Oxford). 2015; 17:1145–1154.
Article
7. Villafane-Ferriol N, Shah RM, Mohammed S, Van Buren G 2nd, Barakat O, Massarweh NN, et al. Evidence-based management of drains following pancreatic resection: a systematic review. Pancreas. 2018; 47:12–17.
8. Robertson N, Gallacher PJ, Peel N, Garden OJ, Duxbury M, Lassen K, et al. Implementation of an enhanced recovery programme following pancreaticoduodenectomy. HPB (Oxford). 2012; 14:700–708.
Article
9. Melnyk M, Casey RG, Black P, Koupparis AJ. Enhanced recovery after surgery (ERAS) protocols: time to change practice? Can Urol Assoc J. 2011; 5:342–348.
Article
10. Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, et al. Postoperative pancreatic fistula: an International Study Group (ISGPF) definition. Surgery. 2005; 138:8–13.
Article
11. Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery. 2017; 161:584–591.
12. Bassi C, Buchler MW, Fingerhut A, Sarr M. Predictive factors for postoperative pancreatic fistula. Ann Surg. 2015; 261:e99.
Article
13. Hackert T, Hinz U, Pausch T, Fesenbeck I, Strobel O, Schneider L, et al. Postoperative pancreatic fistula: we need to redefine grades B and C. Surgery. 2016; 159:872–877.
Article
14. Molinari E, Bassi C, Salvia R, Butturini G, Crippa S, Talamini G, et al. Amylase value in drains after pancreatic resection as predictive factor of postoperative pancreatic fistula: results of a prospective study in 137 patients. Ann Surg. 2007; 246:281–287.
15. Davidson TB, Yaghoobi M, Davidson BR, Gurusamy KS. Amylase in drain fluid for the diagnosis of pancreatic leak in post-pancreatic resection. Cochrane Database Syst Rev. 2017; 4:CD012009.
Article
16. Lu X, Wang X, Fang Y, Chen H, Peng C, Li H, et al. Systematic review and meta-analysis of pancreatic amylase value on postoperative day 1 after pancreatic resection to predict post-operative pancreatic fistula. Medicine (Baltimore). 2016; 95:e2569.
Article
17. Tsujie M, Nakamori S, Miyamoto A, Yasui M, Ikenaga M, Hirao M, et al. Risk factors of pancreatic fistula after pancreaticoduodenectomy - patients with low drain amylase level on postoperative day 1 are safe from developing pancreatic fistula. Hepatogastroenterology. 2012; 59:2657–2660.
Article
18. Kawai M, Tani M, Terasawa H, Ina S, Hirono S, Nishioka R, et al. Early removal of prophylactic drains reduces the risk of intra-abdominal infections in patients with pancreatic head resection: prospective study for 104 consecutive patients. Ann Surg. 2006; 244:1–7.
Full Text Links
  • AHBPS
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr