Drain Amylase on the First Postoperative Day of Whipple Surgery: What Value Is the Best Predictor for Early Drain Removal?

Abstract

Background: The value of drain amylase on the first postoperative day after pancreatic resections has been described as an efficient predictor of pancreatic fistula. In spite of this, the cut-off point below which the drains can be removed early remains controversial. Aim: Validate the use of the amylase on the 1st postoperative day in the correlation with pancreatic fistula and define the value at which early drain removal is safe. Method: Were included patients undergoing Whipple surgery in the period of 2007 to 2016. Group 1 enrolled the ones who did not develop fistula and those who developed biochemical fistula for less than seven days postoperatively and group 2 included patients who developed persistent biochemical fistula between seven and 21 days and those with grade B and C fistula. Results: Sixty-one patients were included, 41 comprised group 1 and 20 group 2. The incidence of abdominal collections, need for reoperation and time of hospitalization were for group 1 and 2, respectively: 17.1%, 17.1% and 9.5 days, and 65%, 40% and 21.1 days. The median of the amylase from the drain at 1st postoperative day was in group 1 and 2, respectively: 175 U/l and 3172.5 U/l (p=0.001). Using a cut-off of 180 to predict the group to which the patient would belong there was obtained sensitivity, specificity, positive predictive value and negative predictive value of 100%, 48.8%, 50% and 100% respectively. Conclusion: It was validated the cut-off value of 180 U/l as appropriate to early drain removal.

Alternative Fistula Risk Score and First Postoperative Day Drain Fluid Amylase as Predictors of Pancreatic Fistula After Pancreatoduodenectomy

“…The correlation between DFA and CR-POPF showed a trend towards fistula occurrence as DFA values increased, which is in agreement with findings from other studies. [11][12][13][14][15][16][17][18][19][20][21][22][23][24] In the present case series, the DFA showed a high discriminatory power, since the means of the two groups had very different magnitudes. The DFA boxplot visually showed its strong predictive power by a significant independent separation of data.…”

“…Bassi et al 12 correlated the DFA with the occurrence of CR-POPF and encouraged the strategy of early removal of the abdominal drain depending on DFA values. 25 The cutoff provided in the literature [11][12][13][14][15][16][17][18][19][20][21][22][23][24] ranged from 90 U/L 21 to 5,000 U/L. 12 Giglio et al 13 performed a meta-analysis with 13 studies and 4,416 patients to assess the accuracy of 11 different DFA cutoff values as predictors of CR-POPF, and found the highest Sp for the value of 5,000 U/L.…”

“…25 Several studies 4,[10][11][12] have pointed out the importance of measuring the aFRS and DFA. With varying diagnostic values, 4,[11][12][13][14][15][16][17][18][19][20][21][22][23][24] the determination of these scores facilitates a more individualized management, considering if the patient is a low-or high-risk of developing CR-POPF. 3,4,[25][26][27][28][29] However, there is still no consensus on which of these scores is better, and whether combining both scores would result in increased accuracy in the selection of patients with a high risk of developing CR-POPF.…”

“…10,11 Visual changes in the appearance of the drain fluid only become evident from postoperative day 5, 12 whereas amylase levels in the drain fluid increase already on postoperative day 1 due to its early and imperceptible extravasation through the anastomosis. Several cutoff values of DFA, [11][12][13][14][15][16][17][18][19][20][21][22][23][24] ranging from 90 U/L 21 to 5,000 U/L, 12 have been described for determining the high risk of developing CR-POPF. The most cited cutoff is ≥5,000 U/L; 12 thus, motivating surgeons to remove the abdominal drain early when DFA values are below the aforementioned cutoff.…”

Abdominal drain amylase on the first day after pancreatectomy: a predictive factor for pancreatic fistula

“…The considerable incidence of PF-CR has prompted other studies to find clinical and laboratory criteria predictive of which patients would evolve or would not with this complication. In this scenario the amylase from the drain on the first postoperative day (AD1PO) stands out, in which research has been carried out to investigate whether this parameter can be used as a tool in the diagnostic exclusion of this complication, and thus asses the removal of the abdominal drain in the first postoperative [6][7][8][9][10][11][12] days of. This practice, which has already been performed in some institutions, is associated with lower rates of intra-abdominal and pulmonary complications, length of hospital stay, and lower hospital costs 13,14 .…”