Meta-analysis of drain amylase content on postoperative day 1 as a predictor of pancreatic fistula following pancreatic resection

Giglio, Mariano Cesare; Spalding, Duncan; Giakoustidis, Alexandros; Bian, Alban Zarzavadjian Le; Jiao, Long R.; Habib, Nagy; Pai, Madhava

doi:10.1002/bjs.10090

Cited by 88 publications

(85 citation statements)

References 52 publications

(133 reference statements)

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“…24 First, prolonged drainage could serve as a pathway for retrograde infection-a process that could potentially transform a benign fluid collection into an abscess. 16 In the current study, patients with a POD 1 DFA >5,000 U/L had their drains removed at the surgeon's discretion given the elevated CR-POPF risk that is associated with this scenario. 3 Although these are attractive notions, it must be emphasized that the actual mechanism remains elusive.…”

Section: Discussionmentioning

confidence: 99%

“…A prospective study by Kawai et al 13 reported lower rates of abdominal complications and pancreatic fistula following early drain removal. 15,16 Within this subgroup, early drain removal was associated with significantly a fewer postoperative complications, including CR-POPF. 15,16 Within this subgroup, early drain removal was associated with significantly a fewer postoperative complications, including CR-POPF.…”

mentioning

confidence: 87%

“…The median years of experience as an attending surgeon was 14 (IQR [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19], and the median career PD volume as an attending surgeon was 265.5 (IQR 98.3-734.8). Soft pancreatic parenchyma was encountered 58.8% of the time.…”

Section: Operative Characteristics Of the Protocol Cohortmentioning

confidence: 99%

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Multicenter, Prospective Trial of Selective Drain Management for Pancreatoduodenectomy Using Risk Stratification

et al. 2017

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Section: Discussionmentioning

confidence: 99%

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confidence: 87%

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Multicenter, Prospective Trial of Selective Drain Management for Pancreatoduodenectomy Using Risk Stratification

et al. 2017

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“…Several surgeons have stated that the reason for these conflicting results is the lack of an ideal technique that is applicable for all patients. Many investigations have been made in an attempt to reduce the rate of POPF after pancreatoduodenectomy. Consequently, several risk factors for POPF have been clarified.…”

Section: Discussionmentioning

confidence: 99%

Randomized clinical trial of duct-to-mucosa versus invagination pancreaticojejunostomy after pancreatoduodenectomy

Senda

Shimizu

Natsume

et al. 2017

British Journal of Surgery

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Background:The postoperative pancreatic fistula (POPF) rate for duct-to-mucosa and invagination anastomosis after pancreatoduodenectomy is still debated. The aim of this RCT was to investigate the POPF rate for duct-to-mucosa versus invagination pancreaticojejunostomy.Methods: Patients were stratified by pancreatic texture and diameter of the main pancreatic duct and randomized to the duct-to-mucosa or invagination group. The primary endpoint was the rate of clinically relevant POPF (defined as grade B or C). Secondary endpoints were suture material cost for pancreaticojejunostomy, drain insertion duration and duration of postoperative hospital stay.Results: Some 120 patients undergoing pancreatoduodenectomy were included following consent. Clinically relevant POPF developed in six of 59 patients (10 per cent) in the invagination group and in 14 of 61 patients (23 per cent) in the duct-to-mucosa group (P = 0⋅077). Duration of drain insertion (6 versus 7 days respectively; P = 0⋅027) and postoperative hospital stay (19 versus 24 days; P = 0⋅015) were shorter in the invagination group. Subgroup analysis for 61 patients with a soft pancreas revealed a lower rate of clinically relevant POPF in the invagination group (10 per cent versus 42 per cent in the duct-to-mucosa group; P = 0⋅010). Among 20 patients with a clinically relevant POPF, the six patients in the invagination group had a shorter duration of drain insertion (38⋅5 days versus 49 days for 14 patients in the duct-to-mucosa group; P = 0⋅028) and postoperative hospital stay (42 versus 54⋅5 days respectively; P = 0⋅028). Conclusion:This study did not demonstrate a superiority of invagination over duct-to-mucosa pancreaticojejunostomy in the risk of POPF. However, in high-risk patients with a soft pancreas, invagination may reduce the risk of clinically relevant POPF compared with duct-to-mucosa. Registration number: UMIN000005890 (http://www.umin.ac.jp).

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“…As the luminal content of the small intestine has a high level of amylase, we wished to measure its level in drain fluid as a biomarker of AL. Estimation of drain amylase has been employed in oesophagectomy and pancreatic surgery to detect anastomotic leaks early . Lee et al .…”

Section: Introductionmentioning

confidence: 99%

Drain fluid amylase as a sensitive biomarker for the early detection of anastomotic leakage in ileal pouch surgery

et al. 2019

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Aim We studied the levels of amylase in drain fluid to investigate its utility as a biomarker of anastomotic leak in ileal pouch patients who did not have a covering loop ileostomy. The luminal contents of the small intestine are high in amylase. Ileal J pouches are formed for restoration of continuity in patients with ulcerative colitis after removal of the colon and rectum. A drain is placed alongside the ileal pouch in the pelvis. Method This study is a retrospective analysis of prospectively collected daily drain fluid amylase levels in consecutive patients undergoing restorative proctectomy and ileal J pouch anal anastomosis, without a covering loop ileostomy, between November 2016 and April 2018. Results Thirteen patients underwent surgery without a covering loop ileostomy. Two patients suffered an anastomotic leak and were returned to theatre, one on day 5 and the other on day 6 postoperatively. The mean daily drain fluid amylase level in those who did not leak was between 25 and 46 U/l with a range of 22–139 U/l for all samples collected. In the two patients who suffered a clinical leak the drain fluid amylase level rose to 22 432 and 10 212 U/l on the day of clinical leak diagnosis. The mean rectal tube (intraluminal) amylase level was 63 097 U/l as measured on day 1 postoperatively. Conclusion In this small cohort of patients, the measurement of drain fluid amylase is a highly sensitive biomarker of clinical anastomotic leak.

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Meta-analysis of drain amylase content on postoperative day 1 as a predictor of pancreatic fistula following pancreatic resection

Abstract: Background: Drain amylase content in the days immediately after major pancreatic resection has

Cited by 88 publications

References 52 publications

Multicenter, Prospective Trial of Selective Drain Management for Pancreatoduodenectomy Using Risk Stratification

Multicenter, Prospective Trial of Selective Drain Management for Pancreatoduodenectomy Using Risk Stratification

Randomized clinical trial of duct-to-mucosa versus invagination pancreaticojejunostomy after pancreatoduodenectomy

Drain fluid amylase as a sensitive biomarker for the early detection of anastomotic leakage in ileal pouch surgery

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