Abstract
Objectives: A postoperative pancreatic fistula (POPF) is defined as a threefold increase in the amylase concentration in abdominal drains on or after the third postoperative day (POD). However, additional lipase fluid analysis is widely used despite lacking evidence. In this study, drain amylase and lipase levels were compared regarding their value in detecting POPF. Methods: We conducted a retrospective study including all patients who underwent pancreatic resections at our center between 2005 and 2016. Drain fluid analysis was performed from day 2 to 5. Results: 990 patients were included in the analysis. Overall, 333 (34%) patients developed a POPF. The median amylase and lipase concentrations at POD 3 in cases with POPF were 11.55 µmol/(s·L) (≈13 ×-fold increase) and 39 µmol/(s·L) (≈39 ×-fold increase), respectively. Seven patients with subsequent POPF (2%) were missed with amylase analysis on POD 3, but detected using 3-fold lipase analysis. The false-positive rate of lipase was 51/424 = 12%. A cutoff lipase value at POD 3 of > 4.88 yielded a specificity of 94% and a sensitivity of 89% for development of a POPF. Increased body mass index turned out as risk factor for the development of POPF in a multivariable model. Conclusions: Threefold-elevated lipase concentration may be used as an indicator of a POPF. However, the additional detection of POPF using simultaneous lipase analysis is marginal. Therefore, assessment of lipase concentration does not provide added clinical value and only results in extra costs.
Highlights
Advances in surgical techniques, perioperative management and increasing centralization at high-volume centers have resulted in a significant reduction in perioperative mortality in patients undergoing pancreatic surgery [1,2,3]
Nine hundred and ninety (990) patients (411 females and 579 males) with a median age of 64 years (IQR 53–73) who underwent pancreatic surgery were included in the analysis (Table 1)
According to the revised guidelines of the International Study Group on Pancreatic Surgery (ISGPS), a Postoperative pancreatic fistula (POPF) is defined as a threefold increase in amylase in the drain fluid when compared to the normal serum value measured at postoperative day three or later [9]
Summary
Perioperative management and increasing centralization at high-volume centers have resulted in a significant reduction in perioperative mortality in patients undergoing pancreatic surgery [1,2,3]. Postoperative morbidity remains challenging and still ranges between 40% and 60%, even at high-volume centers [4]. Is the most common septic, harmful and potentially life-threatening complication after pancreatic surgery [5]. The leakage of pancreatic juice and enzymes from the pancreatic anastomosis predisposes for a broad spectrum of associated complications, which may vary from non-clinically relevant to severe.
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