Utility of drain fluid amylase measurement on the first postoperative day after distal pancreatectomy

Vass, David G.; Hodson, James; Isaac, John; Marudanayagam, R.; Mirza, Darius F.; Muiesan, Paolo; Roberts, Keith; Sutcliffe, Robert P.

doi:10.1016/j.hpb.2017.08.016

Cited by 8 publications

(4 citation statements)

References 45 publications

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“…The drain amylase level has also been cited as a risk factor for POPF, although the superiority of drain amylase on POD1 or POD3 is controversial [19–24]. Our data showed that drain amylase levels on POD3 were similarly valuable as a risk factor for POPF to those recorded on POD1 (Table 2).…”

Section: Discussionsupporting

confidence: 51%

The Clinical Implications of Peripancreatic Fluid Collection After Distal Pancreatectomy

et al. 2019

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Objectives Pancreatic fistula after distal pancreatectomy (DP) remains an unsolved problem, and postoperative CT imaging often demonstrates fluid collection (FC) around the pancreatic remnant. This study sought to clarify the clinical implications of FC. Methods This study enrolled 146 patients who underwent DP. FC was defined as a cyst-like lesion C 10 mm in diameter on CT imaging at postoperative day (POD) 7. FC size, irregularity of FC margin, and air bubbles in FC were investigated. In addition, clinical data were retrospectively collected, and useful predictive factors for postoperative pancreatic fistula (POPF) were analyzed. Results Clinically relevant POPF was observed in 26 patients (17.8%), and FC was detected in 136 patients (94.4%). Multivariate analysis identified FC size and drain amylase levels on POD3 as significant risk factors for POPF. Cutoff values were determined by ROC analyses, and the levels of the FC size and drain amylase on POD3 were determined as 41 mm and 1026 IU/L, respectively. The sensitivity and specificity of FC diameters [ 41 mm were 76.9% and 75.0%, respectively, while those of drain amylase levels [ 1026 IU on POD3 were 73.1% and 75.8%, respectively. Conclusions While treating some FCs after DP was necessary for the management of POPF, others did not require any intervention since most of them spontaneously disappeared. FC size and drain amylase levels on POD3 were found to be significantly associated with POPF and could potentially help to determine appropriate treatment.

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Section: Discussionsupporting

confidence: 51%

The Clinical Implications of Peripancreatic Fluid Collection After Distal Pancreatectomy

et al. 2019

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“…This relationship between DFA concentration and salivary fistula development was consistent with research by Larsen et al [6] which showed an upward trend in DFA concentration with early fistulisation. DFA concentration and perioperative albumin ratio has been reported to be an effective predictor of pancreatic fistula development after pancreatomy [7][8][9], also allowing an assessment for the earlier removal of the drain [10]. We speculate that the reason for the association between DFA concentration and salivary fistula development may be as follows.…”

Section: Discussionmentioning

confidence: 86%

Drain fluid amylase as a predictor of postoperative salivary fistula in cases with benign parotid tumours

Zhang

Peng

et al. 2020

BMC Oral Health

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Background Late diagnosis of a salivary fistula increases the risk of wound infection and scarring. The purpose of the present study was to identify a quantitative predictor of postoperative salivary fistula for cases treated with surgery. Methods Demographic, intraoperative and postoperative parameters for 57 cases that received surgery for benign parotid tumours were recorded from June 2017 to June 2018, of which 18 cases developed salivary fistulas. These data were analysed using univariate and binary logistic regression analyses as well as receiver operating curve analysis. Results Drain fluid amylase concentration was positively correlated with salivary fistula development (p < 0.001), with an odds ratio of 1.14 for a 1 KU/L increase in concentration and an optimal receiver operating curve cut-off value of 51,100 U/L for predicting salivary fistula development. Cases wherein the parotid–masseteric fascia remained intact were associated with a lower risk of salivary fistula development (p = 0.006). Conclusion Drain fluid amylase concentration may be a valuable predictor of postoperative salivary fistula in cases with benign parotid tumours.

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“…A meta-analysis and several large-cohort studies have proven that drain fluid amylase on the first postoperative day is a good predictor of development of pancreatic fistula [ 16 – 18 ]. The results of this study showed that the AUC of the amylase level in the drainage fluid on the first postoperative day for predicting POPF was as high as 0.885, with a sensitivity and specificity of 90% and 81.38%, respectively.…”

Section: Discussionmentioning

confidence: 99%

Drainage volume on postoperative day one to predict clinically relevant postoperative pancreatic fistula following distal pancreatectomy

Zhou

Liu

et al. 2022

BMC Surg

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Background The purpose of this study was to determine how the drain fluid volume on the first day after surgery (DFV 1) can be used to predict clinically relevant post-operative pancreatic fistula following distal pancreatectomy (DP). Method A retrospective analysis of 175 patients who underwent distal pancreatectomy in hepatobiliary surgery at Chengdu 363 Hospital (China) from January 2015 to January 2021 has been performed. Depending on the presence of pancreatic fistula, all patients were divided into two groups: POPF and non-POPF. The clinical factors were analyzed using SPSS 17.0 and Medcalc software. In order to assess the effectiveness of DFV 1 in predicting POPF after surgery, ROC curves were used to calculate its cut-off point,, which yielded sensitivity and negative predictive value of 100% for excluding POPF. Result Of the 175 patients who underwent distal pancreatectomy, the incidence of overall pancreatic fistula was 36%, but the rate of clinically significant (grade B and C) fistula, as defined by the International Study Group on Pancreatic Fistula, 30 was only 17.1% (28 grade B and 2 grade C fistula). The results from univariate and multivariate logistic regression analysis showed that drain fluid volume on the first postoperative day (OR = 0.95, P = 0.03), drainage fluid amylase level on POD1 (OR = 0.99, P = 0.01) and the preoperative ALT level (OR = 0.73, P = 0.02) were independent risk factors associated with CR-POPF. Receiver operating characteristic (ROC) curve analysis revealed that a drainage volume of 156 mL within 24 h and an amylase greater than 3219.2 U/L on the first postoperative day were the optimal thresholds associated with complications. Conclusion After distal pancreatectomy, the drainage volume on the first postoperative day can predict the presence of a clinically relevant pancreatic fistula.

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Utility of drain fluid amylase measurement on the first postoperative day after distal pancreatectomy

Abstract: First postoperative day drain fluid amylase measurement may have a role in excluding pancreatic fistula after distal pancreatectomy. Such patients may be suitable for earlier drain removal.

Cited by 8 publications

References 45 publications

The Clinical Implications of Peripancreatic Fluid Collection After Distal Pancreatectomy

The Clinical Implications of Peripancreatic Fluid Collection After Distal Pancreatectomy

Drain fluid amylase as a predictor of postoperative salivary fistula in cases with benign parotid tumours

Drainage volume on postoperative day one to predict clinically relevant postoperative pancreatic fistula following distal pancreatectomy

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