Intra-Operative Amylase Concentration in Peri-Pancreatic Fluid Predicts Pancreatic Fistula After Distal Pancreatectomy

Abstract

Post-operative pancreatic fistula (POPF) is a potentially severe complication following distal pancreatectomy. The aim of this study was to assess the predictive value of intra-operative amylase concentration (IOAC) in peri-pancreatic fluid after distal pancreatectomy for the diagnosis of POPF. Consecutive patients who underwent a distal pancreatectomy between November 2014 and September 2016 were included in the analysis. IOAC was measured, followed by drain fluid analysis for amylase on post-operative days (PODs) 1, 3, and 5. Receiver operator characteristic (ROC) analysis was performed to evaluate the discriminative capacity of IOAC as a predictor of POPF. IOAC was measured after distal pancreatectomy in 26 patients. The IOAC correlated significantly with (i) PODs 1, 3, and 5 drain amylase (p < 0.01); (ii) the development of POPF (p < 0.01); and (iii) the Clavien-Dindo grade of surgical complications (p = 0.02). Eighty-three percent of patients with an IOAC > 1000 experienced a post-operative complication (OR 18.3, 95% CI 2.51–103, p < 0.01). ROC curve analysis confirmed the predictive relationship of IOAC and POPF as an excellent test with an area under the curve of 0.92 (95% CI 0.81–0.99, p < 0.01). Measurement of IOAC allows early and accurate categorization of patients at risk for POPF in distal pancreatectomy.

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Correspondence to Anubhav Mittal.

Ethics declarations

Ethics approval was obtained from the Northern Sydney Local Health District Human Research Ethics Committee and the North Shore Private Hospital Ethics Committee.

Sources of Funding

Christopher B Nahm is the recipient of a Foundation for Surgery Herbert and Gloria Kees Scholarship from the Royal Australasian College of Surgeons, Sydney Vital, and the Australia New Zealand Hepatic, Pancreatic and Biliary Association for his PhD research.

Additional information

Kleeff J and Diener MK designate shared co-first authorship.

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Nahm, C.B., de Reuver, P.R., Hugh, T.J. et al. Intra-Operative Amylase Concentration in Peri-Pancreatic Fluid Predicts Pancreatic Fistula After Distal Pancreatectomy. J Gastrointest Surg 21, 1031–1037 (2017). https://doi.org/10.1007/s11605-017-3395-0

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Keywords

  • Pancreatectomy
  • Pancreatic fistula
  • Amylase
  • Pancreas