The Combination of Pancreas Texture and Postoperative Serum Amylase in Predicting Pancreatic Fistula Risk

Abstract

Postoperative pancreatic fistula (PF) remains one of the most significant complications after pancreaticoduodenectomy (PD). Recently, studies have suggested that post-PD serum hyper-amylasemia (HA) may be a risk factor. In this study, we evaluate the relationship of pancreas texture and post-operative serum amylase levels in determining PF risk. This retrospective cohort study evaluated all patients who underwent PD at Thomas Jefferson University from 2009 to 2014. The highest postoperative serum amylase level from postoperative day (POD) 0 to POD 5 was obtained. Chi-square analyses and odds ratio (OR) evaluated the relationship between pancreas texture, serum amylase level, and the development of PF. Data from 524 consecutive patients were analyzed. Serum amylase threshold value of 165 IU/L yielded greatest accuracy from the receiver operating characteristic curve analysis (Sensitivity, 0.70; specificity, 0.72). Grade B or C PF were more common among HA patients (20 vs 3%; P < 0.001). HA was associated with increased rates of PD-associated complications. On multivariable analysis, early postoperative serum HA was more predictive of PF risk (OR, 4.87; P < 0.001) than either pancreatic duct size ≤3 mm (OR, 2.97; P = 0.01) or pancreas texture (OR,1.87; P = 0.05). Conclusion: The presence of HA on POD 0 or POD 1 is more predictive than soft pancreas texture or small pancreas duct size alone.

Preoperative serum CA19-9 predicts postoperative pancreatic fistula in PDAC patients: retrospective analysis at a single institution.

“…BMI was an independent risk factor for POPF in this study. These results are consistent with previous reports 23,24 . Higher CA19-9 l is an independent risk factor.…”

Combined prognostic nutritional index ratio and serum amylase level during the early postoperative period predicts pancreatic fistula following pancreaticoduodenectomy

“…However, some reports demonstrated that the concentration of drain amylase does not always match the severity of POPF following pancreaticoduodenectomy [ 9 – 11 ]. Several previous studies indicated that an elevated serum amylase level during the early postoperative period was associated with the development of POPF [ 12 – 14 ]. This may reflect the local response from remnant pancreatic tissue, considering that an elevated serum amylase level represents pancreatitis in the remnant pancreatic tissue or local ischemia, which leads to POPF [ 15 , 16 ].…”

Postpancreatectomy Acute Pancreatitis (PPAP)

“…Due to the widespread familiarity and access to serum amylase values, most studies used elevated serum total amylase activity or its pancreatic isoform as the criterion for the diagnosis 10,12,14,15,17,18,24 . Reports investigating the prognostic implications of the Connor definition invariably identify a significant association between an increase in serum amylase activity, even under the threshold of 3-times the upper limits of normal, 13 and an increase in postoperative morbidity 10,12,14,15,17,18,23,24,51 . This association appeared strengthened when serum pancreatic enzymes activity was combined with increased values of serum C-reactive protein (CRP >180 mg/dL on POD 2).…”