The value of serum amylase and drain fluid amylase to predict postoperative pancreatic fistula after pancreatoduodenectomy: a retrospective cohort study

Jelle C Van Dongen,Casper H J Van Eijck,Steven Merkens,Bas Groot Koerkamp,M Hossein Aziz

doi:10.1007/s00423-021-02192-y

Jelle C Van Dongen, Casper H J Van Eijck + Show 3 more

Open Access

https://doi.org/10.1007/s00423-021-02192-y

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Abstract

PurposeSerum and drain amylase have been identified as important predictors of postoperative pancreatic fistula (POPF) and might be useful to guide postoperative drain management after pancreatoduodenectomy. We aimed to determine and compare the value of serum amylase and drain fluid amylase to predict postoperative pancreatic fistula after pancreatoduodenectomy.MethodsThis retrospective cohort study included patients after pancreatoduodenectomy from 2012 to 2019. The primary endpoint of our study was grade B/C POPF. Serum amylase on postoperative day 1 (SA-1) and drain fluid amylase on postoperative day 2 (DFA-2) were analyzed.ResultsA total of 92 of 437 patients (21.1%) developed a grade B/C POPF. SA-1 was higher in patients who developed a grade B/C POPF (336 U/L vs. 97 U/L, p<0.001). Similarly, DFA-2 was higher in patients who developed a grade B/C POPF (1764 U/L vs. 78 U/L, p<0.001). SA-1 and DFA-2 had similar predictive accuracy (AUC: 0.82 vs. 0.85, respectively, p=0.329). Patients with SA-1<100 U/L (n=178) had a risk of 2.2% of developing grade B/C POPF, compared to 38.2% in patients with SA-1 >100 U/L (n=207). Patients with DFA-2<100 U/L (n=141) had a risk of 0% of developing grade B/C POPF, compared to 36.2% in patients with DFA-2>100 U/L (n=196). SA-1 and DFA-2 were strongly associated at a cut-off of 100 U/L (p<0.001, 89% concordance rate).ConclusionPostoperative serum and drain amylase values below 100 U/L both effectively rule out POPF after pancreatoduodenectomy. The advantage of serum amylase measurement is that it can be used in patients who are managed without surgical drains.

Highlights

Postoperative pancreatic fistula (POPF) is the major determinant of morbidity after pancreatoduodenectomy [1, 2]
serum amylase (SA) can predict postoperative pancreatic fistula (POPF) in patients who are managed without surgical drains
The primary endpoint of this study was the incidence of grade B/C POPF according to the 2016 International Study Group for Pancreatic Fistula definition [20]

Summary

Introduction

Postoperative pancreatic fistula (POPF) is the major determinant of morbidity after pancreatoduodenectomy [1, 2]. Postoperative serum amylase (SA) demonstrated to be an adequate predictor of POPF [10,11,12,13,14]. The removal of postoperative drains is generally based on the drain fluid amylase (DFA) output [7,8,9, 15,16,17,18]. Recent studies advocate a DFA threshold of 90–100 U/L for drain removal [16,17,18], remarkably lower than the 5000 U/L used in a prior randomized controlled trial [7]. Combining SA and DFA might improve prediction of POPF; this has only been studied in small series [12, 19]. SA can predict POPF in patients who are managed without surgical drains

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