Drain fluid amylase on post-operative day 5 as pronostic factor of grade B–C pancreatic fistula after distal pancreatectomy

Abstract

Background: Post-operative pancreatic fistula (POPF) is one of the most feared complications after distal pancreatectomy (DP) and associates an increased morbidity and mortality. Aim: To analyze the incidence and risk factors of POPFs in our series and stratify the risk factors for grade B/C POPFs after DP. Methods: We performed a single-center retrospective study which analyzes patients who underwent DP between 2010 and 2017. We recollected demographic, surgical, post-operative and histological data. Drain fluid amylase was examined on postoperative day 3, 5 and 7, following our protocol. POPFs were classified according to the International Study Group of Pancreatic Fistula definitions. We performed a descriptive analysis and multivariate logistic regression to determine the prognostic factors of POPF Results: A total of 92 patients underwent DP. Laparoscopic approach was performed in 39 (42%) patients, with a conversion rate of 22%. In 85% of the cases we used endostapler and in 24% we performed manual suture of the pancreatic stump. Sealant was placed on the resection surface in 60% of the cases. POPF was diagnosed in 26% of the patients, of whom 19% were grade B-C. None of the variables analyzed were significantly associated with POPF, but the drain fluid amylase >1000 U/L on post-operative day 5, was associated with grade B-C POPFs [OR 20, p = 0.028 (CI 1.301–287)]. Conclusion: In our series, no overall POPF predictive factors were found after DP. However, an elevated drain fluid amylase on post-operative day 5 can predict a worst outcome and should influence our therapeutic strategy.