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World Journal of Surgery

, Volume 36, Issue 4, pp 879–883 | Cite as

Utility of Drain Fluid Amylase Measurement on the First Postoperative Day after Pancreaticoduodenectomy

  • Robert P. Sutcliffe
  • Narendra Battula
  • Ali Haque
  • Amir Ali
  • Parthi Srinivasan
  • Simon W. Atkinson
  • Mohamed Rela
  • Nigel D. Heaton
  • Andreas A. Prachalias
Article

Abstract

Background

Early detection of pancreatic fistula (PF) may improve the outcome after pancreaticoduodenectomy, and exclusion of PF may allow earlier drain removal and accelerate recovery. The aim of the present study was to evaluate the relationship between drain fluid amylase on the first postoperative day (DFA1) and PF.

Patients and methods

This work was designed as a prospective study and included patients undergoing pancreaticoduodenectomy in a single center. For each patient, DFA was measured on the first and fifth postoperative days, and PF was defined by drainage of amylase-rich fluid on the fifth postoperative day (DFA5 >300 U/l). A cut-off value of DFA1 was derived, which yielded sensitivity and negative predictive value of 100% for predicting a PF.

Results

A total of 70 patients (47% male) who underwent pancreaticoduodenectomy (Whipple procedure: 37; pylorus-preserving procedure: 33) between April 2009 and March 2010 were included. Nine of those patients developed a PF (grade A-2; B-5; C-2). There were two postoperative deaths (3%). The DFA1 value significantly correlated with DFA5 (Spearman rank coefficient 0.68; p < 0.0001). The median DFA1 of patients with a PF (6,205; range 357–23,391) was significantly higher than in patients without a PF (69; range 5–5,180; p = 0.01; unpaired t test). No patient with a PF had a DFA1 ≤350 U/l, compared to 48/61 patients (79%) without a PF. Using 350 U/l as a cut-off, a low DFA1 excluded a PF with a sensitivity, specificity, positive and negative predictive values of 100, 79, 41, and 100%, respectively.

Conclusions

Drain fluid amylase on the DFA1 after pancreaticoduodenectomy stratifies patients according to likelihood of developing a PF.

Keywords

Pancreatic Fistula Distal Pancreatectomy Pancreatic Resection Whipple Procedure Drain Removal 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Gilsdorf RB, Spanos P (1972) Factors influencing morbidity and mortality in pancreaticoduodenectomy. Ann Surg 177:332–337Google Scholar
  2. 2.
    Cohen JR, Kuchta N, Geller N et al (1982) Pancreaticoduodenectomy. A 40-year experience. Ann Surg 195:608–617PubMedCrossRefGoogle Scholar
  3. 3.
    DeOliveira ML, Winter JM, Schafer M et al (2006) Assessment of complications after pancreatic surgery: a novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann Surg 244:931–937PubMedCrossRefGoogle Scholar
  4. 4.
    Yang YM, Tian XD, Zhuang Y et al (2005) Risk factors of pancreatic leakage after pancreaticoduodenectomy. World J Gastroenterol 11:2456–2461PubMedGoogle Scholar
  5. 5.
    Gooiker GA, van Gijn W, Wouters MW, Post PN, van de Velde CJ, Tollenaar RA (2011) Signalling Committee Cancer of the Dutch Cancer Society. Systematic review and meta-analysis of the volume-outcome relationship in pancreatic surgery. Br J Surg 98(4):485–494PubMedCrossRefGoogle Scholar
  6. 6.
    Kawai M, Tani M, Hirono S et al (2009) How do we predict the clinically relevant pancreatic fistula after pancreaticoduodenectomy?—an analysis in 244 consecutive patients. World J Surg 33:2670–2678PubMedCrossRefGoogle Scholar
  7. 7.
    Fuks D, Piessen G, Huet E et al (2009) Life-threatening postoperative pancreatic fistula (grade C) after pancreaticoduodenectomy: incidence, prognosis, and risk factors. Am J Surg 197:702–709PubMedCrossRefGoogle Scholar
  8. 8.
    Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M (2005) International Study Group on Pancreatic Fistula Definition. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138(1):8–13PubMedCrossRefGoogle Scholar
  9. 9.
    Petrowsky H, Demartines N, Rousson V et al (2004) Evidence-based value of prophylactic drainage in gastrointestinal surgery: a systematic review and meta-analyses. Ann Surg 240:1074–1084PubMedCrossRefGoogle Scholar
  10. 10.
    Bassi C, Molinari E, Malleo G et al (2010) Early versus late drain removal after standard pancreatic resections: results of a prospective randomized trial. Ann Surg 252:207–214PubMedCrossRefGoogle Scholar
  11. 11.
    Molinari E, Bassi C, Salvia R et al (2007) Amylase value in drains after pancreatic resection as predictive factor of postoperative pancreatic fistula: results of a prospective study in 137 patients. Ann Surg 246:281–287PubMedCrossRefGoogle Scholar
  12. 12.
    Hashimoto N, Ohyanagi H (2002) Pancreatic juice output and amylase level in the drainage fluid after pancreatoduodenectomy in relation to leakage. Hepatogastroenterology 49:553–555PubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2012

Authors and Affiliations

  • Robert P. Sutcliffe
    • 1
  • Narendra Battula
    • 1
  • Ali Haque
    • 2
  • Amir Ali
    • 2
  • Parthi Srinivasan
    • 2
  • Simon W. Atkinson
    • 2
  • Mohamed Rela
    • 2
  • Nigel D. Heaton
    • 2
  • Andreas A. Prachalias
    • 2
  1. 1.Liver UnitQueen Elizabeth HospitalBirminghamUK
  2. 2.Institute of Liver StudiesKing’s College HospitalLondonUK

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