Amylase Level in Drains After Pancreatoduodenectomy as a Predictor of Clinically Significant Pancreatic Fistula

Ceroni, Mauro; J, Galindo; Guerra, Juan Francisco; Salinas, José; Martínez, Jorge; Jarufe, Nicolás

doi:10.1097/mpa.0000000000000060

Cited by 11 publications

(3 citation statements)

References 16 publications

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“…El Nakeeb et al 21 identified POD 1 drain amylase >1000 U/L and POD 5 > 4000 U/L as a highly sensitive and specific marker for PF formation (ROC 0.797, p < 0.0001, ROC 0.96, p < 0.0001). This was also confirmed by Ceroni et al 26 who found that clinically significant PF detection was achieved at drain amylase >2820 U/L on POD 3. Israel et al 27 investigated the use of drain amylase as a negative predictor for PF formation and found that it was safe to remove drains when drain amylase was below 100 U/L on POD 1.…”

Section: Individual Study Characteristicssupporting

confidence: 77%

Impact of surgical drain output monitoring on patient outcomes in hepatopancreaticobiliary surgery: A systematic review

et al. 2021

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Background and objective: Surgical drains are widely utilized in hepatopancreaticobiliary surgery to prevent intra-abdominal collections and identify postoperative complications. Surgical drain monitoring ranges from simple-output measurements to specific analysis for constituents such as amylase. This systematic review aimed to determine whether surgical drain monitoring can detect postoperative complications and impact on patient outcomes. Methods: A systematic review was performed, and the following databases searched between 02/03/20 and 26/04/20: MEDLINE, EMBASE, The Cochrane Library, and Clinicaltrials.gov. All studies describing surgical drain monitoring of output and content in adult patients undergoing hepatopancreaticobiliary surgery were considered. Other invasive methods of intra-abdominal sampling were excluded. Results: The search returned 403 articles. Following abstract review, 390 were excluded and 13 articles were included for full review. The studies were classified according to speciality and featured 11 pancreatic surgery and 2 hepatobiliary surgery studies with a total sample of 3262 patients. Postoperative monitoring of drain amylase detected pancreatic fistula formation and drain bilirubin testing facilitated bile leak detection. Both methods enabled early drain removal. Improved patient outcomes were observed through decreased incidence of postoperative complications (pancreatic fistulas, intra-abdominal infections, and surgical-site infections), length of stay, and mortality rate. Isolated monitoring of drain output did not confer any clinical benefits. Conclusions: Surgical drain monitoring has advantages in the postoperative care for selected patients undergoing hepatopancreaticobiliary surgery. Enhanced surgical drain monitoring involving the testing of drain amylase and bilirubin improves the detection of complications in the immediate postoperative period.

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Section: Individual Study Characteristicssupporting

confidence: 77%

Impact of surgical drain output monitoring on patient outcomes in hepatopancreaticobiliary surgery: A systematic review

et al. 2021

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“…Postoperative DFA levels can provide dynamic evaluation of CR-POPF risk. While some studies suggest that POD3 DFA levels may hold a superior predictive value [ 20 ], POD1 DFA levels remain the most widely used. The University of Verona first proposed that POD1 DFA levels >5,000 U/L indicate a high risk of CR-POPF after PD [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

Serum Creatinine and Amylase in Drain to Predict Pancreatic Fistula Risk after Pancreatoduodenectomy

Song,

Zhang

2023

Dig Surg

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Introduction: The identification of patients with low risk of clinically relevant postoperative pancreatic fistula (CR-POPF) and postoperative hemorrhage (PPH) can guide drain removal after pancreatoduodenectomy (PD). However, drain fluid amylase (DFA) ≤ 5000 U/L on postoperative day (POD) 1 does not robustly predict the absence of CR-POPF. Methods: Consecutive patients undergoing PD at Sun Yat-sen University Cancer Center between July 2018 and October 2021 were analyzed. Recursive partitioning analysis was used to classify patients into groups with different risks of CR-POPF and PPH. Results: Among 288 consecutive patients included, 99 patients (34.38%) developed CR-POPF. Patients with CR-POPF had increased levels of preoperative creatinine (CRE) and POD1 CRE. The combination of POD1 CRE (>104 μmol/L or not) and POD1 DFA (>5000 U/L or not) stratified patients into subgroups with the maximum difference in CR-POPF risk. The CR-POPF rates were 17.82% (36/202) in group A (POD1 CRE ≤ 104 μmol/L and POD1 DFA ≤ 5000 U/L), 53.33% (8/15) in group B (POD1 CRE > 104 μmol/L, and POD1 DFA ≤ 5000 U/L), and 77.46% (55/71) in group C (POD1 DFA > 5000 U/L). The PPH rates were 1.98% (4/202), 20.00% (3/15), and 19.72% (14/71) in groups A, B, and C, respectively. Conclusion: Patients with POD1 DFA ≤ 5000 U/L and POD1 CRE >104 μmol/L have a high risk of CR-POPF and may not benefit from early drain removal. Patients with POD1 DFA ≤ 5000 U/L and POD1 CRE ≤104 μmol/L have low risk of CR-POPF and PPH.

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“…Following pancreatoduodenectomy, POD3 drain amylase has been noted to be significantly higher in CR-POPF patients[ 91 ]. Diagnostic cut-offs for POD3 drain amylase have ranged between 26 U/L and 1026 U/L for distal pancreatectomy cohorts[ 54 , 56 , 92 , 93 ], 93-2820 U/L for pancreatoduodenectomy cohorts[ 55 , 56 , 83 , 84 , 94 - 99 ] and 200-3000 U/L in studies analysing the biomarker in pancreatectomy patients[ 16 , 56 , 75 , 100 - 103 ]. When cut-off accuracy was reported, sensitivity ranged from 0.316-1.00 and specificity, from 0.631-0.968[ 16 , 55 , 75 , 84 , 92 , 94 - 98 , 101 - 103 ], showing drain amylase alone does not completely include or exclude CR-POPF.…”

Section: Introductionmentioning

confidence: 99%

Drain fluid biomarkers for prediction and diagnosis of clinically relevant postoperative pancreatic fistula: A narrative review

Rykina-Tameeva¹,

Samra²,

Sahni³

et al. 2022

World J Gastrointest Surg

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Clinically relevant postoperative pancreatic fistula (CR-POPF) has continued to compromise patient recovery post-pancreatectomy despite decades of research seeking to improve risk prediction and diagnosis. The current diagnostic criteria for CR-POPF requires elevated drain fluid amylase to present alongside POPF-related complications including infection, haemorrhage and organ failure. These worrying sequelae necessitate earlier and easily obtainable biomarkers capable of reflecting evolving CR-POPF. Drain fluid has recently emerged as a promising source of biomarkers as it is derived from the pancreas and hence, capable of reflecting its postoperative condition. The present review aims to summarise the current knowledge of CR-POPF drain fluid biomarkers and identify gaps in the field to invigorate future research in this critical area of clinical need. These findings may provide robust diagnostic alternatives for CR-POPF and hence, to clarify their clinical utility require further reports detailing their diagnostic and/or predictive accuracy.

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Amylase Level in Drains After Pancreatoduodenectomy as a Predictor of Clinically Significant Pancreatic Fistula

Abstract: Patients with CS-PF have higher values of ALD than patients who developed a mild/transient fistula. An ALD higher than 2820 U/L identifies patients likely to present a CS-PF.

Cited by 11 publications

References 16 publications

Impact of surgical drain output monitoring on patient outcomes in hepatopancreaticobiliary surgery: A systematic review

Impact of surgical drain output monitoring on patient outcomes in hepatopancreaticobiliary surgery: A systematic review

Serum Creatinine and Amylase in Drain to Predict Pancreatic Fistula Risk after Pancreatoduodenectomy

Drain fluid biomarkers for prediction and diagnosis of clinically relevant postoperative pancreatic fistula: A narrative review

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