Predictive effect of postoperative 1st day drain amylase value on the development of pancreatic fistula that occurs after pancreaticoduodenectomy: a prospective clinicalal study

Abstract

Introduction: The diagnosis of postoperative pancreatic fistula (POPF) is established according to the value of drain amylase. However, the time of the removal of drain is controversial. The aim of this study was to determine the predictive effect of the postoperative 1st day drain amylase values on the development of POPF. Methods: This study was conducted on 135 patients undergone PD between August 2015 and August 2017. Drain amylase on the postoperative 1st, 3rd, and 5t days were recorded. Clinic-related pancreatic fistula was determined according to the criteria of the International Study Group of Pancreatic Fistula revised in 2017 (Grade B/C). The cut-off values of postoperative 1st day drain amylase were detected according to the ROC analysis for using in the prediction of the development of clinic-related POPF. Results: In 18 of 135 patients (13%), grade B and C POPF developed. The median postoperative 1st day value of drain amylase was 7153 (440-138300 U/L) in patients developing fistula. The AUC value was found to be 0,91 (p = 0,0001; 95% CI: 0,865–0,973) for the prediction of POPF determined by using postoperative 1st day drain amylase. In the prediction of POPF development, 1st day drain amylase cut-off value was 1363 U/L. The duration of hospitalization was longer in patients having the cut-off value of >1363 U/L (p < 0,001). Conclusions: Drain amylase on the postoperative 1st day can be useful for early detection of POPF. The postoperative 1st day drain amylase >1363 U/L is a risk factor for the development of POPF. However, further prospective studies on larger populations are needed for reliable cut-off value.