Article

Does Postoperative Drain Amylase Predict Pancreatic Fistula after Pancreatectomy?

University of Wisconsin School of Medicine and Public Health, Department of Surgery, Section of Surgical Oncology, Madison, WI
Journal of the American College of Surgeons (Impact Factor: 4.45). 05/2014; 218(5). DOI: 10.1016/j.jamcollsurg.2014.01.048

ABSTRACT Background
Previous studies suggest that after pancreatectomy, drain fluid amylase obtained on postoperative day 1 (DFA1) >5000 U/L correlates with the development of postoperative pancreatic fistula (PF).1,2 We sought to validate whether DFA1 is a clinically useful predictor of PF and to evaluate whether DFA1 correlates with PF severity.

Study Design
Using a prospective database, we reviewed records from patients having pancreatectomy between 2010 and 2012. Presence and grade of PF were determined using the consensus guidelines from the International Study Group on Pancreatic Fistula (ISGPF).1

Results
Sixty-three patients who underwent pancreatectomy had a documented DFA1. There were 27 (43%) who developed PF: 2 (7%) were grade A, 18 grade B (67%), and 7 grade C (26%). Median DFA1 in patients with PF (4600 U/L, range 32—16,900) was significantly higher than in those without (45 U/L, range 2—5840; p <0.001). When DFA1 was analyzed at varying cutoff values, correlation of DFA1 with PF was high. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were assessed at varying levels of DFA1. Highest sensitivity (96%) and NPV (96%) were obtained with a cutoff DFA1 of < 100 U/L. On multivariate analysis, DFA1 >100 was the only significant predictor of PF when controlling for gland texture, duct size, pathology, and neoadjuvant radiation. There was no statistically significant relationship between DFA1 and PF grade.

Conclusions
In patients undergoing pancreatic resection, a cutoff of DFA1 <100 resulted in high sensitivity and NPV. Early drain removal may be safe in these patients. Further studies are recommended to validate the role of DFA1 in excluding PF and assisting in management of surgical drains.

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