Does Postoperative Drain Amylase Predict Pancreatic Fistula after Pancreatectomy?

Low Drain Fluid Amylase Predicts Absence of Pancreatic Fistula Following Pancreatectomy

“…11 Recently, another single institution study revealed that DFA1<100 U/L was associated with very low risk of pancreatic fistula (sensitivity of 96 % and NPV of 96 %). 10 …”

“…5–10 However, these studies have shown variable results with respect to cutoff levels. Molinari et al proposed that DFA1>5,000 U/L was a significant predictor of pancreatic fistula.…”

Can early serum lipase measurement be routinely implemented to rule out clinically significant pancreatic fistula after pancreaticoduodenectomy?

“…In particular, it has been attempted to identify an ideal cut-off below which the probability of development of the fistula is reasonably low. Molinari [13] identified a threshold for amylase in the drainage of 5000 U/L, whereas Sutcliff [14] and Israel [15] calculated cut-offs lower than 350 U/L and 100 U/L, respectively. Interestingly, the high NPV reported in these studies (100% and 96% on POD1) helps surgeons to stratify the risk of POPF after PD.…”

Systematic review and meta-analysis of pancreatic amylase value on postoperative day 1 after pancreatic resection to predict postoperative pancreatic fistula

“…4,7,[17][18][19][20][21][22][23][24][25][26][27][28][29] The process of selecting trials for inclusion is shown in Figure 1. The characteristics of these 15 studies are shown in Table 1.…”

“…The Fagan plot in DPA1 for overall POPF [17][18][19][20][21][22][24][25][26][27][28][29] calculated that the positive post-test probabilities (post-test (þ)) were 0.57, 0.80, 0.92 respectively, and the negative posttest probabilities (post-test (À)) were 0.04, 0.10, 0.25 respectively when the pretest probability was 25% or 50% or 75%. For PPA1 [22,[27][28][29], the post-tests (þ) were 0.39, 0.66, 0.85 respectively, and the post-tests (À) were 0.12, 0.30, 0.56 respectively.…”