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Early biochemical predictors of clinically relevant pancreatic fistula after distal pancreatectomy: a role for serum amylase and C-reactive protein

  • 2021 SAGES Oral
  • Published:
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Abstract

Background

Recent evidence suggests that pancreatic inflammation plays a pivotal role in the occurrence of clinically relevant postoperative pancreatic fistula (CR-POPF) after pancreaticoduodenectomy but few data are available for distal pancreatectomy (DP). The aim of this study was to evaluate the impact of early biochemical markers on the occurrence of CR-POPF after DP.

Methods

Clinical and laboratory data for 432 consecutive DP patients were reviewed. Serum amylase was evaluated on postoperative day (POD) 1, and drain fluid amylase (DFA) and C-reactive protein (CRP) were evaluated on POD 2 and 3. Receiver operator characteristic (ROC) curves were performed for all biochemical markers and an area under the curve (AUC) was computed. Multivariable regression analyses to identify the factors associated with CR-POPF and severe postoperative morbidity (Clavien–Dindo grade ≥ 3) were performed.

Results

At 90 days after surgery, CR-POPF occurred in 155 (36%) patients, severe complications in 66 (15%) patients. ROC curve analyses showed that DFA on POD2 had the largest AUC (0.753, p < 0.001), followed by serum amylase on POD 1 (0.651, p < 0.001), serum CRP on POD3 (0.644, p < 0.001), and CRP change between POD 2 and POD 3 (0.644, p < 0.001). Multivariable analysis identified male gender (OR 2.29, 95% CI 1.36–3.86; p = 0.002), DFA ≥ 1500 U/L on POD2 (OR 4.63, 95% CI 2.72–7.89; p < 0.001), serum amylase ≥ 100 U/L on POD 1 (OR 1.72, 95% CI 1.01–2.93; p = 0.046), and CRP increase by at least 25 mg/L on POD 3 compared to the previous day (OR 1.89, 95% CI 1.11–3.21; p = 0.019) as independent predictors of CR-POPF, yielding a valid regression model (AUC 0.765, 95% CI 0.714–0.816, p < 0.001).

Conclusions

Postoperative serum amylase and CRP trajectory represent useful early biochemical markers for CR-POPF in addition to DFA. Our findings suggest that these laboratory tests should be incorporated into clinical practice to aid postoperative patient and drain management.

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Acknowledgements

Giovanni Guarneri research fellowship is funded by the Umberto Veronesi Foundation.

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Authors and Affiliations

  1. Division of Pancreatic Surgery, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milano, Italy

    Nicolò Pecorelli, Giovanni Guarneri, Stefano Crippa, Stefano Partelli & Massimo Falconi

  2. Vita-Salute San Raffaele University, Milan, Italy

    Nicolò Pecorelli, Giovanni Guarneri, Marco Palucci, Lorenzo Gozzini, Alessia Vallorani, Stefano Crippa, Stefano Partelli & Massimo Falconi

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  1. Nicolò Pecorelli
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  2. Giovanni Guarneri
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  3. Marco Palucci
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  4. Lorenzo Gozzini
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  5. Alessia Vallorani
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  6. Stefano Crippa
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Correspondence to Massimo Falconi.

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Nicolò Pecorelli, Giovanni Guarneri, Marco Palucci, Lorenzo Gozzini, Alessia Vallorani, Stefano Crippa, Stefano Partelli, and Massimo Falconi have no conflict of interest or financial ties to disclose.

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Pecorelli, N., Guarneri, G., Palucci, M. et al. Early biochemical predictors of clinically relevant pancreatic fistula after distal pancreatectomy: a role for serum amylase and C-reactive protein. Surg Endosc 36, 5431–5441 (2022). https://doi.org/10.1007/s00464-021-08883-3

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