Intra-Operative Amylase Concentration in Peri-Pancreatic Fluid Predicts Pancreatic Fistula After Distal Pancreatectomy.
Post-operative pancreatic fistula (POPF) is a potentially severe complication following distal pancreatectomy. The aim of this study was to assess the predictive value of intra-operative amylase concentration (IOAC) in peri-pancreatic fluid after distal pancreatectomy for the diagnosis of POPF. Consecutive patients who underwent a distal pancreatectomy between November 2014 and September 2016 were included in the analysis. IOAC was measured, followed by drain fluid analysis for amylase on post-operative days (PODs) 1, 3, and 5. Receiver operator characteristic (ROC) analysis was performed to evaluate the discriminative capacity of IOAC as a predictor of POPF. IOAC was measured after distal pancreatectomy in 26 patients. The IOAC correlated significantly with (i) PODs 1, 3, and 5 drain amylase (p < 0.01); (ii) the development of POPF (p < 0.01); and (iii) the Clavien-Dindo grade of surgical complications (p = 0.02). Eighty-three percent of patients with an IOAC > 1000 experienced a post-operative complication (OR 18.3, 95% CI 2.51-103, p < 0.01). ROC curve analysis confirmed the predictive relationship of IOAC and POPF as an excellent test with an area under the curve of 0.92 (95% CI 0.81-0.99, p < 0.01). Measurement of IOAC allows early and accurate categorization of patients at risk for POPF in distal pancreatectomy.
Upper Gastrointestinal Surgical Unit, Department of Gastrointestinal Surgery, Royal North Shore Hospital, Reserve Road, St. Leonards, 2065, NSW, Australia.|North Shore Private Hospital, Reserve Road, St. Leonards, 2065, NSW, Australia.|Northern Clinical School, The University of Sydney, Sydney, NSW, Australia.
Christopher B
CB
Nahm
Department of Surgery, Radboudumc, Nijmegen, The Netherlands.
Philip R
PR
de Reuver
Upper Gastrointestinal Surgical Unit, Department of Gastrointestinal Surgery, Royal North Shore Hospital, Reserve Road, St. Leonards, 2065, NSW, Australia.|North Shore Private Hospital, Reserve Road, St. Leonards, 2065, NSW, Australia.|Northern Clinical School, The University of Sydney, Sydney, NSW, Australia.
Thomas J
TJ
Hugh
Upper Gastrointestinal Surgical Unit, Department of Gastrointestinal Surgery, Royal North Shore Hospital, Reserve Road, St. Leonards, 2065, NSW, Australia.|North Shore Private Hospital, Reserve Road, St. Leonards, 2065, NSW, Australia.
Andrew
A
Pearson
Northern Clinical School, The University of Sydney, Sydney, NSW, Australia.|Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, Australia.
Anthony J
AJ
Gill
Upper Gastrointestinal Surgical Unit, Department of Gastrointestinal Surgery, Royal North Shore Hospital, Reserve Road, St. Leonards, 2065, NSW, Australia.|North Shore Private Hospital, Reserve Road, St. Leonards, 2065, NSW, Australia.|Northern Clinical School, The University of Sydney, Sydney, NSW, Australia.
Jaswinder S
JS
Samra
Upper Gastrointestinal Surgical Unit, Department of Gastrointestinal Surgery, Royal North Shore Hospital, Reserve Road, St. Leonards, 2065, NSW, Australia. mittal.surgery@gmail.com.|North Shore Private Hospital, Reserve Road, St. Leonards, 2065, NSW, Australia. mittal.surgery@gmail.com.|Northern Clinical School, The University of Sydney, Sydney, NSW, Australia. mittal.surgery@gmail.com.
Anubhav
A
Mittal
D000368:Aged; D000681:Amylases / Q000378:metabolism*; D004322:Drainage; D005122:Exudates and Transudates / Q000201:enzymology*; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects*; D010185:Pancreatic Fistula / Q000209:etiology*; D010189:Pancreatic Juice / Q000201:enzymology*; D011183:Postoperative Complications / Q000209:etiology*; D011184:Postoperative Period; D011237:Predictive Value of Tests; D012372:ROC Curve; D018570:Risk Assessment / Q000379:methods; D013997:Time Factors
D000681:Amylases
Amylase; Pancreas; Pancreatectomy; Pancreatic fistula