Which is the best predictor of clinically relevant pancreatic fistula after pancreatectomy: drain fluid concentration or total amount of amylase?

Fukami, Yasuyuki; Saito, Takuya; Osawa, Tsutomu; Hanazawa, Takaaki; Kurahashi, Takehiro; Kurahashi, Shintaro; Matsumura, Tatsuki; Komatsu, Shunichiro; Kaneko, Kenitiro; Sano, Tsuyoshi

doi:10.1002/ags3.12471

Cited by 13 publications

(10 citation statements)

References 27 publications

(109 reference statements)

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“…The role of DFAC on day 1 in the prediction of POPF after pancreatectomy has been extensively investigated (24). However, it has been recently shown that high DFAC on day 3 is also independently associated with POPF after PD (25). Early detection of high-risk POPF patients is a real challenge for the clinician, because when latent, POPF is significantly associated with more intra-abdominal abscesses, reintervention, and especially more PPH (26).…”

Section: Discussionmentioning

confidence: 99%

Late Postpancreaticoduodenectomy Hemorrhage: Incidence, Risk Factors, Management and Outcome

Jacquemin

Mokart

Ewald

et al. 2022

Shock

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Background:Postpancreaticoduodenectomy (PD) hemorrhage (PPH) is a life-threatening complication after PD. The main objective of this study was to evaluate incidence and factors associated with late PPH as well as the management strategy and outcomes. Methods: Between May 2017 and March 2020, clinical data from 192 patients undergoing PD were collected prospectively in the CHIRPAN Database (NCT02871336) and retrospectively analyzed. In our institution, all patients scheduled for a PD are routinely admitted for monitoring and management in intensive/intermediate care unit (ICU/IMC). Results: The incidence of late PPH was 17% (32 of 192), whereas the 90-day mortality rate of late PPH was 19% (6 of 32). Late PPH was associated with 90-day mortality (P = 0.001). Using multivariate analysis, independent risk factors for late PPH were postoperative sepsis (P = 0.036), and on day 3, creatinine (P = 0.025), drain fluid amylase concentration (P = 0.023), lipase concentration (P < 0.001), and C-reactive protein (CRP) concentration (P < 0.001). We developed two predictive scores for PPH occurrence, the PANCRHEMO scores. Score 1 was associated with 68.8% sensitivity, 85.6% specificity, 48.8% predictive positive value, 93.2% negative predictive value, and an area under the receiver operating characteristic curves of 0.841. Score 2 was associated with 81.2% sensitivity, 76.9% specificity, 41.3% predictive positive value, 95.3% negative predictive value, and an area under the receiver operating characteristic curve of 0.859. Conclusions: Routine ICU/IMC monitoring might contribute to a better management of these complications. Some predicting factors such as postoperative sepsis and biological markers on day 3 should help physicians to determine patients requiring a prolonged ICU/IMC monitoring.

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Section: Discussionmentioning

confidence: 99%

Late Postpancreaticoduodenectomy Hemorrhage: Incidence, Risk Factors, Management and Outcome

Jacquemin

Mokart

Ewald

et al. 2022

Shock

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“…The D-Amy level in the ISGPF were commonly measured on POD3. Some studies [29][30][31] have reported the D-Amy level on POD3 in predicting POPF. However, various D-Amy level on POD3 cut-off values have been proposed.…”

Section: Discussionmentioning

confidence: 99%

“…Kanda et al [30] mentioned that the D-Amy level on POD3 was independently associated with POPF after DP, they also stated that the best cut-off value of D-Amy on POD3 was >1918 U/L. Fukami et al [31] showed that the best cut-off value of D-Amy on POD3 was >1044 U/L. They also revealed that the D-Amy on POD3 was early predictive factor of POPF after both PD and DP, and that that cut-off value of D-Amy on POD3 after DP (>3506U/L) tended to be higher than after PD (>713 U/L).…”

Section: Discussionmentioning

confidence: 99%

Early predictive factors for postoperative pancreatic fistula after distal pancreatectomy for pancreatic cancer: A retrospective study

Fukada

Murase

Higashi

et al. 2022

Preprint

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Background: Postoperative pancreatic fistula (POPF) is the most serious complication of distal pancreatectomy (DP). When POPF occurs and becomes severe, it causes secondary complications and leads to a longer treatment period. Therefore, especially for pancreatic cancer (PC), POPF may have a negative impact on not only short-term outcomes, but also on postoperative treatment. This study aimed to identify early predictive factors of POPF after DP for PC.Methods: This retrospective, single-institution study comprised of 55 patients with PC who underwent DP (excluding simultaneous resection of other organs and other pancreatic diseases) between January 2010 and December 2021 at the Gifu University Hospital. We statistically analyzed pre-, intra-, and post-operative 23 factors to identify early predictive factors for POPF. Results: According to the definition and grading of the International Study Group of Pancreatic Fistula (ISGPF), 12 (21.8%) of 55 patients had POPF grades B and C. In the univariate analysis, POPF was significantly associated with the pancreas-to-muscle signal intensity ratio on T1-weighted magnetic resonance imaging (SIR on T1-w MRI), the drainage fluid amylase (D-Amy) level on postoperative day 3 (POD3), C-reactive protein (CRP) on POD3, and heart rate on POD3. In multivariate analysis, pancreas-to-muscle SIR on T1-w MRI (>1.37; odds ratio [OR] 17.08; 95% confidence interval [CI] 1.64 – 598.16; p = 0.02), D-Amy level on POD3 (>1200 U/L; OR 20.00; 95% CI 1.73 – 563.83; p = 0.02) and heart rate on POD3 (>100 bpm; OR 15.33; 95% CI 1.53 – 258.45; p = 0.02) were identified as independent early predictive factors for POPF. Conclusion: Preoperative pancreas-to-muscle SIR on T1-w MRI and postoperative D-Amy level and heart rate significantly correlated with POPF after DP for PC. Postoperative management based on these predictive factors may contribute to shortened hospital stay and smooth introduction to postoperative treatment.

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“…The amylase level in drains on POD1 in patients with post-operative complications after Whipple resection was significantly higher than that in patients without complications (5052.22±2871.68 vs. 664.12±341.45 U/L, p<0.000). Patients with amylase levels in drains ³971.50 U/L had significantly higher risks of POPF Grade C (RR: 31.43; 95% CI: [9,[25][26][27][28].…”

Section: Discussionmentioning

confidence: 99%

Urine amylase level after Whipple resection might be a predictive factor of postoperative complications

Ljuca

Tursunović

Ljuca

et al. 2022

Bosn J of Basic Med Sci

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The association between urine amylase levels and the development of postoperative complications after Whipple resection is still unknown. Aim of this study was to determine the prognostic value of urine amylase levels for postoperative complications in patients who underwent Whipple resection. In this retrospective cohort study, we analyzed amylase levels in urine, serum and drains in 52 patients who underwent Whipple resection preoperatively and on Postoperative Day 1 (POD1) after the intervention. Patients were followed up for 3 months to assess their predictive value for postoperative complications. In patients with complications, urine amylase levels were significantly higher on POD1 than before resection (198.89 ± 28.41 vs. 53.70 ± 7.44, p=0.000). Considering the sensitivity and specificity of the urine amylase level on POD1, an area under the ROC curve of 0.918 was obtained (p<0.001, 95% CI: 0.894-0.942). Patients with urine amylase levels ³140.00 U/L had significantly higher risks of postoperative pancreatic fistula (POPF) grade C (definition of POPF done according to the ISGP) (RR:20.26; 95% CI: 1.18-347.07; p=0.038), readmission to hospital (RR: 6.61; 95% CI: 1.53-28.58; p=0.011), reoperation (RR: 5.67; 95% CI: 1.27-25.27; p=0.023), and mortality (RR:17.00; 95% CI: 2.33-123.80; p=0.005) than patients with urine amylase levels <140.00 U/L. Urine amylase levels on POD1 displayed strong and significant positive correlations with serum amylase levels (r=0.92, p=0.001) and amylase levels in drains (r=0.86, p=0.002). We can conclude that urine amylase levels on POD1 have good prognostic value for postoperative complications after Whipple resection and might be used as an additional predictive risk factor.

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Which is the best predictor of clinically relevant pancreatic fistula after pancreatectomy: drain fluid concentration or total amount of amylase?

Abstract: This is an open access article under the terms of the Creat ive Commo ns Attri bution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 13 publications

References 27 publications

Late Postpancreaticoduodenectomy Hemorrhage: Incidence, Risk Factors, Management and Outcome

Late Postpancreaticoduodenectomy Hemorrhage: Incidence, Risk Factors, Management and Outcome

Early predictive factors for postoperative pancreatic fistula after distal pancreatectomy for pancreatic cancer: A retrospective study

Urine amylase level after Whipple resection might be a predictive factor of postoperative complications

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