title: Postoperative serum amylase predicts pancreatic fistula formation following pancreaticoduodenectomy.
abstract: BACKGROUND
  Early identification of patients at risk for developing pancreatic fistula (PF) after pancreaticoduodenectomy (PD) may facilitate prevention or treatment strategies aimed at reducing its associated morbidity.
  
  
  METHODS
  A retrospective review of 176 consecutive PD performed between 2006 and 2011 was conducted in order to analyze the association between the serum amylase on postoperative day 1 (POD1) and the development of PF.
  
  
  RESULTS
  Serum amylase was recorded on POD1 in 146 of 176 PD cases (83.0 %). Twenty-seven patients (18.5 %) developed a postoperative PF: 6 type A, 19 type B, and 2 type C. Patients with a PF had a mean serum amylase on POD1 of 659 ± 581 compared to 246 ± 368 in those without a fistula (p < 0.001). On logistic regression, a serum amylase >140 U/L on POD1 was strongly associated with developing a PF (OR, 5.48; 95 % CI, 1.94-15.44). Sensitivity and specificity of a postoperative serum amylase >140 U/L was 81.5 and 55.5 %, respectively. Positive and negative predictive values were 29.3 and 93.0 %, respectively.
  
  
  CONCLUSIONS
  An elevated serum amylase on POD1 may be used, in addition to other prognostic factors, to help stratify risk for developing PF following PD.
authors.affiliation: Department of Surgery, Stanford University, 300 Pasteur Dr, H3591, Stanford, CA, 94305, USA.
authors.forename: Jordan M
authors.initials: JM
authors.lastname: Cloyd
authors.forename: Zachary J
authors.initials: ZJ
authors.lastname: Kastenberg
authors.forename: Brendan C
authors.initials: BC
authors.lastname: Visser
authors.forename: George A
authors.initials: GA
authors.lastname: Poultsides
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Norton
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D000681:Amylases / Q000097:blood*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010185:Pancreatic Fistula / Q000097:blood* / Q000209:etiology*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D010359:Patient Readmission; D011184:Postoperative Period; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors
chemical_list: D000681:Amylases
references.citation: HPB (Oxford). 2011 Jul;13(7):503-10
references.pmid: 21689234
references.citation: J Gastrointest Surg. 2004 Nov;8(7):766-72; discussion 772-4
references.pmid: 15531229
references.citation: Ann Surg. 2007 Aug;246(2):281-7
references.pmid: 17667507
references.citation: Ann Surg. 2006 Dec;244(6):931-7; discussion 937-9
references.pmid: 17122618
references.citation: Br J Surg. 2001 Feb;88(2):190-9
references.pmid: 11167865
references.citation: Surg Gynecol Obstet. 1989 Nov;169(5):451-3
references.pmid: 2814757
references.citation: Acta Chir Belg. 2007 Jul-Aug;107(4):373-7
references.pmid: 17966528
references.citation: World J Surg. 2008 Mar;32(3):419-28
references.pmid: 18175170
references.citation: J Am Coll Surg. 1997 Jul;185(1):18-24
references.pmid: 9208956
references.citation: World J Surg. 2012 Apr;36(4):879-83
references.pmid: 22354484
references.citation: J Am Coll Surg. 2007 May;204(5):1029-36; discussion 1037-8
references.pmid: 17481534
references.citation: J Hepatobiliary Pancreat Surg. 2007;14(6):557-63
references.pmid: 18040620
references.citation: Hepatogastroenterology. 2003 Jul-Aug;50(52):1155-8
references.pmid: 12846003
references.citation: Ann Surg. 1995 Oct;222(4):580-8; discussion 588-92
references.pmid: 7574936
references.citation: J Gastrointest Surg. 2006 Nov;10(9):1280-90; discussion 1290
references.pmid: 17114014
references.citation: Pancreas. 2006 Jul;33(1):45-52
references.pmid: 16804412
references.citation: Arch Surg. 2010 Jul;145(7):634-40
references.pmid: 20644125
references.citation: Arch Surg. 2005 Sep;140(9):849-54; discussion 854-6
references.pmid: 16172293
references.citation: J Am Coll Surg. 2007 Oct;205(4):546-57
references.pmid: 17903728
references.citation: Int Surg. 2004 Jan-Mar;89(1):39-45
references.pmid: 15085997
references.citation: Br J Surg. 2005 Sep;92(9):1117-23
references.pmid: 15931656
references.citation: Arch Surg. 2008 Oct;143(10):956-65
references.pmid: 18936374
references.citation: J Clin Oncol. 1997 Mar;15(3):928-37
references.pmid: 9060530
references.citation: World J Gastroenterol. 2008 Oct 14;14(38):5789-96
references.pmid: 18855976
references.citation: Adv Surg. 2008;42:33-48
references.pmid: 18953808
references.citation: HPB (Oxford). 2013 Feb;15(2):142-8
references.pmid: 23297725
references.citation: J Surg Res. 2007 May 1;139(1):22-9
references.pmid: 17292419
references.citation: J Am Coll Surg. 2013 Apr;216(4):635-42; discussion 642-4
references.pmid: 23521944
references.citation: Surgery. 2005 Jul;138(1):8-13
references.pmid: 16003309
references.citation: Arch Surg. 2008 May;143(5):476-81
references.pmid: 18490557
references.citation: Ann Surg. 1997 Nov;226(5):632-41
references.pmid: 9389397
references.citation: Cochrane Database Syst Rev. 2012 Jun 13;(6):CD008370
references.pmid: 22696379
references.citation: Ann Surg. 2007 Sep;246(3):425-33; discussion 433-5
references.pmid: 17717446
references.citation: Am Surg. 2011 Mar;77(3):257-69
references.pmid: 21375833
references.citation: J Gastrointest Surg. 2012 Mar;16(3):518-23
references.pmid: 22083531
references.citation: J Gastrointest Surg. 2004 Dec;8(8):951-9
references.pmid: 15585382
references.citation: World J Gastroenterol. 2007 Oct 28;13(40):5351-6
references.pmid: 17879405
references.citation: World J Gastroenterol. 2005 Apr 28;11(16):2456-61
references.pmid: 15832417
references.citation: J Gastrointest Surg. 2012 Jan;16(1):89-102; discussion 102-3
references.pmid: 22065319
references.citation: Ann Surg. 2012 Sep;256(3):529-37
references.pmid: 22868373
references.citation: Ann Surg. 2001 Oct;234(4):487-93; discussion 493-4
references.pmid: 11573042
references.citation: Ann Surg. 2000 Sep;232(3):419-29
references.pmid: 10973392
references.citation: Ann Surg. 2010 Aug;252(2):207-14
references.pmid: 20622661
references.citation: J Am Coll Surg. 2013 Jan;216(1):1-14
references.pmid: 23122535
references.citation: World J Surg. 2013 Jun;37(6):1405-18
references.pmid: 23494109