Systematic Review and Meta-Analysis of Pancreatic Amylase Value on Postoperative Day 1 After Pancreatic Resection to Predict Postoperative Pancreatic Fistula

Lü, Xiang; Wang, Xinjing; Fang, Yuan; Chen, Hao; Peng, Chenghong; Li, Hongwei; Deng, Xiaxing; Shen, Baiyong

doi:10.1097/md.0000000000002569

Cited by 15 publications

(7 citation statements)

References 33 publications

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“…Previous studies1417 by Tsujie et al17 have reported that patients with low drain amylase level on post-operative day 1 are safe from developing POPF 16. This translates to improved confidence in removing surgically-placed pancreatic drains at POD 3, in patients with low drain amylase values at POD 1 and 3.…”

Section: Discussionmentioning

confidence: 96%

“…Some studies identified a patient with pancreatic fistula after radiological confirmation, before using ISGPF classification to stratify POPF. Others used drain amylase value cut-offs >1000 U/L to >4000 U/L on POD 1, to define POPF 16. In our study, biochemistry was used as primary assessment for presence of POPF, and only patients with clinical signs and biochemically raised drain amylase value at POD 3 or after, had computed tomography to confirm presence of POPF.…”

Section: Discussionmentioning

confidence: 99%

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Predictive value of post-operative drain amylase levels for post-operative pancreatic fistula

Serene

Padmakumar

et al. 2018

Ann Hepatobiliary Pancreat Surg

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Backgrounds/AimsTraditionally, surgically placed pancreatic drains are removed, at the discretion of the operating surgeon. Moving towards enhanced recovery after surgery (ERAS), we looked for predictors for early drain removal. The purpose of this paper was to establish which postoperative days' (POD) drain amylase is most predictive against post-operative pancreatic fistula (POPF).MethodsWe conducted a retrospective study of 196 patients who underwent pancreatic resection at our institute from January 2006 to October 2013. Drain amylase levels were routinely measured. The International Study Group of Pancreatic Fistula (ISGPF) definition of POPF, and clinical severity grading were used.Results5.1% (10 of 196) patients developed ISGPF Grades B and C POPF. Negative predictive value of developing significant POPF, if drain amylase values were low on PODs 1 and 3 was 98.7% (95% CI: 0.93–1.00). This translated to confidence in removing surgically placed pancreatic drains, at POD 1 and 3 when drain amylase values are low.ConclusionsPatients with low drain amylase values on POD 1 and 3, are unlikely to develop POPF and may have pancreatic drains removed earlier.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Predictive value of post-operative drain amylase levels for post-operative pancreatic fistula

Serene

Padmakumar

et al. 2018

Ann Hepatobiliary Pancreat Surg

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“…Visual changes in the appearance of the drain fluid only become evident from postoperative day 5 22 , whereas amylase levels in the drain fluid increase already on postoperative day 1 due to its early and imperceptible extravasation through the anastomosis. Several cutoff values of DFA 1,6,8,[14][15][16][17]22,25 , ranging from 90 14 to 5,000 U/L 22 , have been described for determining the high risk of developing CR-POPF. The most cited cutoff value is 5,000 U/L 22 , thus motivating surgeons to remove the abdominal drain early when DFA values are below the aforementioned cutoff 28 .…”

Section: Central Messagementioning

confidence: 99%

“…Several studies 22,24,32 have pointed out the importance of measuring the aFRS and DFA. With varying diagnostic values 1,6,8,[14][15][16][17]22,24,25 , the determination of these scores facilitates a more individualized management, considering if the patient is at low or high risk of developing CR-POPF 4,12,18,24,30 . However, there is still no consensus on which of these scores is better and whether combining both scores would result in increased accuracy in the selection of patients with a high risk of developing CR-POPF.…”

Section: Central Messagementioning

confidence: 99%

Alternative Fistula Risk Score and First Postoperative Day Drain Fluid Amylase as Predictors of Pancreatic Fistula After Pancreaticoduodenectomy

Longo

Bassaneze

Peres

et al. 2023

ABCD, arq. bras. cir. dig.

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BACKGROUND: The high morbidity and mortality rates of pancreaticoduodenectomy are mainly associated with pancreaticojejunal anastomosis, the most fragile and susceptible to complications such as clinically relevant postoperative pancreatic fistula. AIMS: The alternative fistula risk score and the first postoperative day drain fluid amylase are predictors of the occurrence of clinically relevant postoperative pancreatic fistula. No consensus has been reached on which of the scores is a better predictor; moreover, their combined predictive power remains unclear. To the best of our knowledge, this association had not yet been studied. METHODS: This study assessed the predictive effect of alternative fistula risk score and/or drain fluid amylase on clinically relevant postoperative pancreatic fistula in a retrospective cohort of 58 patients following pancreaticoduodenectomy. The Shapiro-Wilk and Mann-Whitney tests were applied for assessing the distribution of the samples and for comparing the medians, respectively. The receiver operating characteristics curve and the confusion matrix were used to analyze the predictive models. RESULTS: The alternative fistula risk score values were not statistically different between patients in the clinically relevant postoperative pancreatic fistula and non- clinically relevant postoperative pancreatic fistula groups (Mann-Whitney U test 59.5, p=0.12). The drain fluid amylase values were statistically different between clinically relevant postoperative pancreatic fistula and non- clinically relevant postoperative pancreatic fistula groups (Mann-Whitney U test 27, p=0.004). The alternative fistula risk score and drain fluid amylase were independently less predictive for clinically relevant postoperative pancreatic fistula, compared to combined alternative fistula risk score + drain fluid amylase. CONCLUSION: The combined model involving alternative fistula risk score >20% + drain fluid amylase=5,000 U/L was the most effective predictor of clinically relevant postoperative pancreatic fistula occurrence following pancreaticoduodenectomy.

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“…Therefore, the markers for pancreatic function may be used as predictors of the development of post-operative complications after Whipple resection. Several studies [8][9][10][11] have shown an association between amylase levels in drains and serum with post-operative complications after pancreaticoduodenectomy.…”

Section: Introductionmentioning

confidence: 99%

Urine amylase level after Whipple resection might be a predictive factor of postoperative complications

Ljuca

Tursunović

Ljuca

et al. 2022

Bosn J of Basic Med Sci

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The association between urine amylase levels and the development of postoperative complications after Whipple resection is still unknown. Aim of this study was to determine the prognostic value of urine amylase levels for postoperative complications in patients who underwent Whipple resection. In this retrospective cohort study, we analyzed amylase levels in urine, serum and drains in 52 patients who underwent Whipple resection preoperatively and on Postoperative Day 1 (POD1) after the intervention. Patients were followed up for 3 months to assess their predictive value for postoperative complications. In patients with complications, urine amylase levels were significantly higher on POD1 than before resection (198.89 ± 28.41 vs. 53.70 ± 7.44, p=0.000). Considering the sensitivity and specificity of the urine amylase level on POD1, an area under the ROC curve of 0.918 was obtained (p<0.001, 95% CI: 0.894-0.942). Patients with urine amylase levels ³140.00 U/L had significantly higher risks of postoperative pancreatic fistula (POPF) grade C (definition of POPF done according to the ISGP) (RR:20.26; 95% CI: 1.18-347.07; p=0.038), readmission to hospital (RR: 6.61; 95% CI: 1.53-28.58; p=0.011), reoperation (RR: 5.67; 95% CI: 1.27-25.27; p=0.023), and mortality (RR:17.00; 95% CI: 2.33-123.80; p=0.005) than patients with urine amylase levels <140.00 U/L. Urine amylase levels on POD1 displayed strong and significant positive correlations with serum amylase levels (r=0.92, p=0.001) and amylase levels in drains (r=0.86, p=0.002). We can conclude that urine amylase levels on POD1 have good prognostic value for postoperative complications after Whipple resection and might be used as an additional predictive risk factor.

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Systematic Review and Meta-Analysis of Pancreatic Amylase Value on Postoperative Day 1 After Pancreatic Resection to Predict Postoperative Pancreatic Fistula

Abstract: Supplemental Digital Content is available in the text

Cited by 15 publications

References 33 publications

Predictive value of post-operative drain amylase levels for post-operative pancreatic fistula

Predictive value of post-operative drain amylase levels for post-operative pancreatic fistula

Alternative Fistula Risk Score and First Postoperative Day Drain Fluid Amylase as Predictors of Pancreatic Fistula After Pancreaticoduodenectomy

Urine amylase level after Whipple resection might be a predictive factor of postoperative complications

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