title: Can the measurement of amylase in drain after distal pancreatectomy predict post-operative pancreatic fistula?
abstract: BACKGROUND
  The most frequent reason for performing a distal pancreatectomy is the presence of cystic or neuroendocrine tumors, in which the distal pancreatic stump is often soft and non fibrotic. This parenchymal consistence represents the main risk factor for post-operative pancreatic fistula. In order to identify the fistula and assessing its severity postoperative monitoring of amylase from intraperitoneal drains is important.
  
  
  METHODS
  From a retrospective multicentric database analysis were included 33 patients who underwent distal pancreatectomy for pancreatic neoplastic disease.
  
  
  RESULTS
  Postoperative pancreatic fistula occurred in four cases. One patient had a ductal adenocarcinoma, two presented with pancreatic endocrine neoplasms and the last one had an intraductal papillary mucinous neoplasia. Two patients underwent open, the other two laparoscopic distal pancreatectomy.
  
  
  CONCLUSIONS
  Postoperative pancreatic fistulas after distal pancreatectomy worsen the quality of life, prolong the post-operative stay and delay further adjuvant therapy. In patients who underwent distal pancreatectomy literature exposed some advantages deriving from the placement of abdominal drainages only in selected cases and from their early removal. Patients presenting a high risk of pancreatic fistula had higher amylase levels of drainage fluid in the first postoperative day.
  
  
  CONCLUSIONS
  POPF is the most frequently complication after pancreatectomy. In our analysis DFA1>5000 can be considered as a predictive factor for pancreatic fistula. For this reason, the systematic measurement of amylase in drain fluid in first-postoperative day can be considered a good clinical practice.
authors.affiliation: Department of General and Oncologic Surgery, University of Perugia, Terni, Italy. Electronic address: roberto.cirocchi@unipg.it.
authors.forename: Roberto
authors.initials: R
authors.lastname: Cirocchi
authors.affiliation: General and Emergency Surgery, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy. Electronic address: luiginagraziosi@yahoo.it.
authors.forename: Luigina
authors.initials: L
authors.lastname: Graziosi
authors.affiliation: Department of General Surgery, Saint Mary Hospital, University of Perugia, Terni, Italy. Electronic address: a.sanguinetti@aospterni.it.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Sanguinetti
authors.affiliation: Department of General and Oncologic Surgery, University of Perugia, Perugia, Italy. Electronic address: carloboselli@yahoo.it.
authors.forename: Carlo
authors.initials: C
authors.lastname: Boselli
authors.affiliation: Department of General Surgery, Saint Mary Hospital, University of Perugia, Terni, Italy. Electronic address: apolis74@yahoo.it.
authors.forename: Andrea
authors.initials: A
authors.lastname: Polistena
authors.affiliation: Department of General and Oncologic Surgery, University of Perugia, Perugia, Italy. Electronic address: renzicla@virgilio.it.
authors.forename: Claudio
authors.initials: C
authors.lastname: Renzi
authors.affiliation: Department of General and Oncologic Surgery, University of Perugia, Terni, Italy. Electronic address: djdesi85@hotmail.it.
authors.forename: Jacopo
authors.initials: J
authors.lastname: Desiderio
authors.affiliation: Department of General and Oncologic Surgery, University of Perugia, Perugia, Italy. Electronic address: giuseppe.noya@unipg.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Noya
authors.affiliation: Department of Digestive Surgery, St. Maria Hospital, Terni, Italy. Electronic address: amilcareparisi@virgilio.it.
authors.forename: Amilcare
authors.initials: A
authors.lastname: Parisi
authors.affiliation: Kumamoto Regional Medical Center, Japan. Electronic address: mhirota@krmc.or.jp.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Hirota
authors.affiliation: General and Emergency Surgery, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy. Electronic address: annibale.donini@unipg.it.
authors.forename: Annibale
authors.initials: A
authors.lastname: Donini
authors.affiliation: Department of General Surgery, Saint Mary Hospital, University of Perugia, Terni, Italy. Electronic address: nicolaavenia@libero.it.
authors.forename: Nicola
authors.initials: N
authors.lastname: Avenia
mesh_terms: D000328:Adult; D000368:Aged; D000681:Amylases / Q000378:metabolism*; D004322:Drainage; D005260:Female; D006801:Humans; D007558:Italy; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects; D010185:Pancreatic Fistula / Q000175:diagnosis* / Q000209:etiology; D010190:Pancreatic Neoplasms / Q000601:surgery; D011183:Postoperative Complications; D011237:Predictive Value of Tests; D012189:Retrospective Studies
chemical_list: D000681:Amylases
keywords: Distal pancreatectomy; Drain amylase; Pancreatic fistula