Negative predictive value of drain amylase concentration for development of pancreatic fistula after pancreaticoduodenectomy

Zelga, Piotr; Ali, Jason M.; Brais, Rebecca; Harper, S.; Liau, Siong‐Seng; Huguet, Emmanuel; Jamieson, Neville V.; Praseedom, Raaj K.; Jah, Asif

doi:10.1016/j.pan.2014.12.003

Cited by 9 publications

(10 citation statements)

References 47 publications

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“…Interestingly, diabetes was negatively associated with PDC in the overall cohort, whereas subgroup analysis showed no association between diabetes and PDC in those without POPF. The reason for this is that diabetes has a negative correlation with POPF in our series, which is concordant with other reports [32][33][34]. Similarly, vessel resection was also a negative predictor for PDC in the overall cohort, while the difference was not significant in a subgroup analysis.…”

Section: Discussionsupporting

confidence: 93%

Clinical significance of drain fluid culture after pancreaticoduodenectomy

Yang

Jin

et al. 2018

J Hepato Biliary Pancreat

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Background The mechanism of infected postoperative pancreatic fistula (POPF) following pancreaticoduodenectomy (PD) is undefined. Drain amylase has been used to predict POPF, whereas little data are available about the value of drain fluid culture. The aim was to investigate the incidence, risk factors and association with surgical outcomes of positive drainage culture (PDC) after PD. Methods A single‐center retrospective analysis was conducted of prospectively collected data from patients who underwent PD between January 2005 and December 2015. Drain fluid samples were obtained for microbiological analysis after surgery. Risk factors for PDC were evaluated, and its influence on surgical outcomes was explored. Results Of 768 patients, 261 (34%) had PDC during the postoperative period. Among them, a total of 434 isolates were yielded. One hundred and seven (24.7%) were Gram‐positive, 283 (65.2%) Gram‐negative, and 44 (10.1%) fungi. Multivariate analysis revealed that body mass index (BMI) ≥25 kg/m2, preoperative chemoradiation and intra‐operative red blood cell transfusion were independent risk factors for PDC. PDC was associated with higher incidences of complications including POPF, major complications and reoperation, but with no correlation between the day of PDC and complications. BMI ≥25 kg/m2, early PDC (≤3 days), main pancreatic duct <3 mm, and soft pancreas were revealed as independent predictors for POPF. There was a correlation between type of microorganisms and complications. Conclusion Considering the correlation between PDC and postoperative complications, preventive measures are crucial to improve outcomes after PD. Whether antibiotic treatment for early PDC will alter the clinical course of POPF needs further evaluation.

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Section: Discussionsupporting

confidence: 93%

Clinical significance of drain fluid culture after pancreaticoduodenectomy

Yang

Jin

et al. 2018

J Hepato Biliary Pancreat

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“…The full text of each of the remaining 49 articles was examined in more detail. This led to the exclusion of a further 36 studies, leaving 13 that were subsequently included in the meta‐analysis ( Fig . ).…”

Section: Resultsmentioning

confidence: 99%

“…Of these, 4079 (92·4 per cent) had a pancreaticoduodenectomy, 321 (7·3 per cent) underwent distal pancreatectomy and 16 had an enucleation (0·4 per cent). The ISGPF criteria for the definition and diagnosis of POPF were used as a reference standard by all but two of the studies, in which the Cambridge definition of POPF and CT findings were used as the reference standard.…”

Section: Resultsmentioning

confidence: 99%

“…All studies graded POPF using the ISGPF criteria. Drain amylase levels were evaluated as a predictor of POPF of any grade in seven studies, as a predictor of clinically relevant POPF in five studies and as a predictor of both in one study. The prevalence of POPF of any grade ranged from 0·11 to 0·43, and the prevalence of clinically relevant POPF ranged from 0·03 to 0·39.…”

Section: Resultsmentioning

confidence: 99%

“…Four studies were retrospective. The QUADAS‐2 instrument highlighted concerns of bias in the index test category in seven studies as their threshold was not prespecified ( Fig. S1 , supporting information).…”

Section: Resultsmentioning

confidence: 99%

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Meta-analysis of drain amylase content on postoperative day 1 as a predictor of pancreatic fistula following pancreatic resection

Giglio

Spalding

Giakoustidis

et al. 2016

British Journal of Surgery

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Amylase in drain fluid for the diagnosis of pancreatic leak in post-pancreatic resection

Davidson

Yaghoobi

Davidson

et al. 2017

Cochrane Database of Systematic Reviews

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Because of the paucity of data and methodological deficiencies in the studies, we are uncertain whether drain fluid amylase should be used as a method for testing for pancreatic leak in an unselected population after pancreatic resection; and we judge that the optimal cut-off of drain fluid amylase for making the diagnosis of pancreatic leak is also not clear. Further well-designed diagnostic test accuracy studies with pre-specified index test threshold of drain fluid amylase (at three times more on postoperative day 5 or another suitable pre-specified threshold), appropriate follow-up (for at least six to eight weeks to ensure that there are no pancreatic leaks), and clearly defined reference standards (of surgical, clinical, and radiological confirmation of pancreatic leak) are important to reliably determine the diagnostic accuracy of drain fluid amylase in the diagnosis of pancreatic leak.

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Negative predictive value of drain amylase concentration for development of pancreatic fistula after pancreaticoduodenectomy

Cited by 9 publications

References 47 publications

Clinical significance of drain fluid culture after pancreaticoduodenectomy

Clinical significance of drain fluid culture after pancreaticoduodenectomy

Meta-analysis of drain amylase content on postoperative day 1 as a predictor of pancreatic fistula following pancreatic resection

Amylase in drain fluid for the diagnosis of pancreatic leak in post-pancreatic resection

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