Serum amylase on the night of surgery predicts clinically significant pancreatic fistula after pancreaticoduodenectomy.
OBJECTIVE
Drainage after pancreaticoduodenectomy (PD) remains controversial because the risk for uncontrolled postoperative pancreatic fistula (POPF) must be balanced against the potential morbidity associated with prolonged and possibly unnecessary drainage. This study investigated the utility of the level of serum amylase on the night of surgery [postoperative day (PoD) 0 serum amylase] to predict POPF.


METHODS
A total of 185 patients who underwent PD were studied. Occurrences of POPF were graded using the International Study Group on Pancreatic Fistula (ISGPF) classification. Receiver operating characteristic (ROC) analysis identified a threshold value of PoD 0 serum amylase associated with clinically significant POPF (ISGPF Grades B and C) in a test cohort (n = 45). The accuracy of this threshold value was then tested in a validation cohort (n = 140).


RESULTS
Overall, 43 (23.2%) patients developed clinically significant POPF. The threshold value of PoD 0 serum amylase for the identification of clinically significant POPF was ≥ 130 IU/l (P = 0.003). Serum amylase of <130 IU/l had a negative predictive value of 88.8% for clinically significant POPF (P < 0.001). Serum amylase of ≥ 130 IU/l on PoD 0 and a soft pancreatic parenchyma were independent risk factors for clinically significant POPF.


CONCLUSIONS
Postoperative day 0 serum amylase of <130 IU/l allows for the early and accurate categorization of patients at least risk for clinically significant POPF and may identify patients suitable for early drain removal.
West of Scotland Pancreatic Unit, Glasgow Royal Infirmary, Glasgow, UK; Academic Department of Surgery, University of Glasgow, Glasgow, UK.
Lavanniya K
LK
Palani Velu
Vishnu V
VV
Chandrabalan
Salman
S
Jabbar
Donald C
DC
McMillan
Colin J
CJ
McKay
C Ross
CR
Carter
Nigel B
NB
Jamieson
Euan J
EJ
Dickson
D000681:Amylases / Q000097:blood*; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D020878:Device Removal; D004322:Drainage / Q000009:adverse effects / Q000295:instrumentation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010185:Pancreatic Fistula / Q000097:blood / Q000201:enzymology / Q000209:etiology* / Q000401:mortality; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000401:mortality; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D015415:Biomarkers; D000681:Amylases