title: Is routine imaging necessary after pancreatic resection? An appraisal of postoperative ultrasonography for the detection of pancreatic fistula.
abstract: OBJECTIVE
  This study aimed to assess whether routine transabdominal ultrasonography (US) is clinically helpful for the early detection of postoperative pancreatic fistula (PF).
  
  
  METHODS
  In a prospective cohort of patients undergoing partial pancreatectomy, US was performed on postoperative day (POD) 3. Potential predictors of PF, including amylase value in drains (AVD) on POD 1, were investigated. A tree-based classification model of the independent predictors of PF was also performed.
  
  
  RESULTS
  One hundred seventy-three patients were analyzed. A peripancreatic collection on US and an AVD 5000 U/L or greater on POD 1 were predictors of PF. In the tree-based classification model, patients were stratified by AVD on POD 1. For values less than 5000 U/L (incidence of PF, 11.3%), US had a sensitivity of 23.1% and a specificity of 97.5%. For AVD 5000 U/L or greater (incidence of PF, 70.7%), sensitivity was 46.3% and specificity was 100%.
  
  
  CONCLUSIONS
  Despite the presence of a peripancreatic collection as a predictor of PF, US-as a diagnostic test-resulted to be highly specific but poorly sensitive even in the tree-based classification model. Therefore, its role does not seem to be clinically relevant and does not add value to AVD on POD 1, which remains the most powerful and relevant early predictor of PF.
authors: From the *Unit of Surgery B, The Pancreas Institute, Department of Surgery and Oncology; and †Department of Radiology, University of Verona Hospital Trust, Verona, Italy.
authors: Giuseppe
authors: G
authors: Malleo
authors: Roberto
authors: R
authors: Salvia
authors: Giovanni
authors: G
authors: Butturini
authors: Mirko
authors: M
authors: D'Onofrio
authors: Enrico
authors: E
authors: Martone
authors: Giovanni
authors: G
authors: Marchegiani
authors: Anna
authors: A
authors: Malpaga
authors: Enrico
authors: E
authors: Molinari
authors: Claudio
authors: C
authors: Bassi
mesh_terms: D000328:Adult; D000368:Aged; D000681:Amylases / Q000378:metabolism; D004322:Drainage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000473:pathology / Q000601:surgery*; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods; D010185:Pancreatic Fistula / Q000175:diagnosis* / Q000209:etiology; D011183:Postoperative Complications / Q000175:diagnosis* / Q000209:etiology; D011184:Postoperative Period; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013997:Time Factors; D014463:Ultrasonography / Q000379:methods*
chemical_list: D000681:Amylases