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Drain Lipase Levels and Decreased Rate of Drain Amylase Levels as Independent Predictors of Pancreatic Fistula with Nomogram After Pancreaticoduodenectomy

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Abstract

Background

Pancreaticoduodenectomy (PD) has recently been improved due to its increased safety. However, postoperative pancreatic fistula (POPF) remains a lethal complication of PD. Identifying novel clinicophysiological risk factors for POPF during the early post-PD period would help improve patient morbidity and mortality. Therefore, this retrospective study aimed to evaluate possible risk factors during the early postoperative period after pancreaticoduodenectomy (PD).

Methods

Data from 349 patients who underwent PD between 2007 and 2012 were examined retrospectively. All patients were classified into 2 groups: group A, patients without fistulae or biochemical leaks (288 patients), and group B, those with grade B or C POPF (61 patients). Data on various clinicophysiological parameters, including serum and drain laboratory data, were collected. Univariate and multivariate analyses were performed to evaluate POPF predictors. A predictive nomogram was established for these results.

Results

Univariate analysis showed that various serum and drain-related factors, such as white blood cell count, C-reactive protein levels, drain amylase (DAMY) levels, and drain lipase (DLIP) levels, were possible POPF risk factors. Multivariate analysis confirmed that postoperative day (POD) 1 DLIP levels (hazard ratio, 15.393; p = 0.037) and decreased rate (POD3/1) of DAMY levels (hazard ratio, 4.415; p = 0.028) were independent risk factors. Further, POD1 DLIP levels and decreased rate of DAMY levels were significantly lower in group A than in group B. The accuracy of nomogram was 0.810.

Conclusions

POD1 DLIP levels (> 245 U/mL) and decreased rate of DAMY levels (> 0.44) were POPF risk factors, making them possible biomarkers for POPF.

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Acknowledgements

No financial support was received for this study. The authors declare no conflicts of interest associated with this study.

Funding

No financial support was received for this study.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Ibaraki Medical Center, Tokyo Medical University, 3-20-1 Chuo, Amimachi, Inashikigun, Ibaraki, 300-0395, Japan

    Shuji Suzuki, Mitsugi Shimoda, Jiro Shimazaki, Yukio Oshiro & Kiyotaka Nishida

  2. Department of Gastroenterological Surgery, Tokyo Women’s Medical University, Tokyo, Japan

    Masahiro Shiihara, Wataru Izumo & Masakazu Yamamoto

Authors
  1. Shuji Suzuki
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  2. Mitsugi Shimoda
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  3. Jiro Shimazaki
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  4. Yukio Oshiro
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  5. Kiyotaka Nishida
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  6. Masahiro Shiihara
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  7. Wataru Izumo
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Correspondence to Shuji Suzuki.

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The requirement for obtaining written informed consent from each patient was waived because of the retrospective study design.

Human or animal rights

This study was approved by the Research Ethics Committee of Tokyo Women’s Medical University (acceptance number: 4605). All procedures were performed in accordance with the ethical standards of the Institutional Research Committee and the 1964 Helsinki Declaration.

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Suzuki, S., Shimoda, M., Shimazaki, J. et al. Drain Lipase Levels and Decreased Rate of Drain Amylase Levels as Independent Predictors of Pancreatic Fistula with Nomogram After Pancreaticoduodenectomy. World J Surg 45, 1921–1928 (2021). https://doi.org/10.1007/s00268-021-06038-y

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