title: Amylase level in drains after pancreatoduodenectomy as a predictor of clinically significant pancreatic fistula.
abstract: OBJECTIVE
  Amylase level in drains (ALD) has been proposed as a predictor for the development of a clinically significant pancreatic fistula (CS-PF) in patients undergoing a major pancreatic surgery. This study aimed to determine if the ALD in patients who developed a CS-PF after pancreatoduodenectomy is higher than that for patients with transient fistulae and to establish a threshold value as a predictor of a CS-PF.
  
  
  METHODS
  From January 2002 to December 2012, all patients undergoing pancreatoduodenectomy were enrolled. At least 1 ALD measurement on postoperative day 3 was obtained. Pancreatic fistula (PF) was defined according to the International Study Group on Pancreatic Fistula. Both grade B and C PFs were considered as a CS-PF. We determined the cutoff value with a receiver operating characteristic curve.
  
  
  RESULTS
  A total of 135 patients were enrolled. Pancreatic fistula was diagnosed in 36 cases (26.7%). The ALD median values were the following: PF grade A, 1809 U/L; PF grade B, 19,710 U/L; and PF grade C, 27,590 U/L. A drain amylase value of 2820 U/L was determined to be the cutoff for the development of a CS-PF.
  
  
  CONCLUSIONS
  Patients with CS-PF have higher values of ALD than patients who developed a mild/transient fistula. An ALD higher than 2820 U/L identifies patients likely to present a CS-PF.
authors.affiliation: From the Department of Digestive Surgery, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Marco
authors.initials: M
authors.lastname: Ceroni
authors.forename: José
authors.initials: J
authors.lastname: Galindo
authors.forename: Juan Francisco
authors.initials: JF
authors.lastname: Guerra
authors.forename: José
authors.initials: J
authors.lastname: Salinas
authors.forename: Jorge
authors.initials: J
authors.lastname: Martínez
authors.forename: Nicolás
authors.initials: N
authors.lastname: Jarufe
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000681:Amylases / Q000378:metabolism*; D004322:Drainage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010185:Pancreatic Fistula / Q000175:diagnosis* / Q000209:etiology; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000175:diagnosis* / Q000209:etiology; D012372:ROC Curve; D018570:Risk Assessment / Q000379:methods / Q000706:statistics & numerical data; D013997:Time Factors
chemical_list: D000681:Amylases