World Journal of Surgery

, Volume 37, Issue 10, pp 2436–2442 | Cite as

Usefulness of Drain Amylase, Serum C-Reactive Protein Levels and Body Temperature to Predict Postoperative Pancreatic Fistula After Pancreaticoduodenectomy

  • Masahide Hiyoshi
  • Kazuo ChijiiwaEmail author
  • Yoshiro Fujii
  • Naoya Imamura
  • Motoaki Nagano
  • Jiro Ohuchida



Postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD) is a worrisome and life-threatening complication. Recently, early drain removal has been recommended as a means of preventing POPF. The present study sought to determine how to distinguish clinical POPF from non-clinical POPF in the early postoperative period after PD to aid in early drain removal.


From March 2002 through December 2010, 176 patients underwent PD and were enrolled in this study to examine factors predictive of clinical POPF after PD. POPF was defined and classified according to the International Study Group of Pancreatic Surgery guideline, and grade B/C POPF was defined as clinical POPF.


Grade A POPF occurred in 39 (22.2 %) patients, grade B in 19 (10.8 %) patients, and grade C in 11 (6.3 %) patients. Clinical POPF (grade B/C) occurred in 17.1 % of patients. Multivariate analysis revealed male gender and body mass index (BMI) ≥22.5 kg/m2 to be the independent preoperative risk factors predictive of POPF. Receiver operating characteristic curves showed that the combination of drain amylase ≥750 IU/L, C-reactive protein (CRP) ≥20 mg/dL, and body temperature ≥37.5 °C on postoperative day 3 could effectively distinguish clinical POPF from non-clinical POPF. Sensitivity, specificity, and accuracy were 84.6, 98.2, and 95.7 %, respectively.


Male gender and BMI ≥22.5 were the independent preoperative predictive risk factors for POPF. We assume that when amylase is <750 IU/L, serum CRP is <20 mg/dL, and body temperature is <37.5 °C the drain can safely be removed, even if POPF is indicated.


Transcatheter Arterial Embolization Portal Vein Resection Postoperative Pancreatic Fistula Soft Pancreas Pancreatic Texture 
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.



This study was supported in part by a Grant-in-Aid for Scientific Research to K.C. (No. 20591635) from the Ministry of Education, Culture, Sports, Science and Technology in Japan.


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Copyright information

© Société Internationale de Chirurgie 2013

Authors and Affiliations

  • Masahide Hiyoshi
    • 1
  • Kazuo Chijiiwa
    • 1
    Email author
  • Yoshiro Fujii
    • 1
  • Naoya Imamura
    • 1
  • Motoaki Nagano
    • 1
  • Jiro Ohuchida
    • 1
  1. 1.Department of Surgical Oncology and Regulation of Organ FunctionUniversity of Miyazaki School of MedicineMiyazakiJapan

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