Predictive value of amylase content of drainage fluid for clinically relevant postoperative pancreatic fistula after laparoscopic pancreaticoduodenectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

CHEN Dong ,  WANG Ji , MA Hongqin , LIU Li , DU Yusheng , ZHAO Wenxing

Department of General Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221700, P. R. China;

Corresponding author：

WANG Ji, Email: drwangji@gmail.com

Keywords：

laparoscopic pancreaticoduodenectomy; clinically relevant pancreatic fistula; drainage fluid amylase

DOI：

10.7507/1007-9424.202010078

Video：

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Objective To investigate value of drainage fluid amylase content and other risk factors in predicting clinically relevant postoperative pancreatic fistula (CR-POPF) after laparoscopic pancreaticoduodenectomy (LPD).Methods The clinical data of 166 patients who underwent LPD in this hospital from January 2017 to December 2019 were retrospectively analyzed. The independent risk factors of CR-POPF after LPD were analyzed. And the sensitivity and specificity of drainage fluid amylase content obtained on postoperative day 1 and 3 (Abbreviated as DFA1 and DFA3, respectively) in predicting CR-POPF by receiver operating characteristic (ROC) curve.Results A total of 166 patients underwent LPD were collected in this study. The CR-POPF occurred in 16 (9.6%) patients and all of them were grade B. The DFA1 (P=0.037), DFA3 (P<0.001), and positive bacterial culture of drainage fluid after operation (P=0.020) were the independent risk factors of CR-POPF after LPD (P<0.05) by the logistic regression multivariate analysis. The area under the ROC curve of the DFA1 and DFA3 in predicting CR-POPF was 0.880 [95%CI (0.812, 0.949)] and 0.912 [95%CI (0.853, 0.971)] respectively, and the corresponding best critical value was 3 925 and 939 U/L, and the sensitivity was 100% and 100%, specificity was 64.0% and 70.7%, respectively.Conclusion For patients with DFA1>3 925 U/L, DFA3>939 U/L, and positive bacterial culture of drainage fluid after operation, preventive measures should be made to avoid CR-POPF.

Citation： CHEN Dong, WANG Ji, MA Hongqin, LIU Li, DU Yusheng, ZHAO Wenxing. Predictive value of amylase content of drainage fluid for clinically relevant postoperative pancreatic fistula after laparoscopic pancreaticoduodenectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(7): 910-914. doi: 10.7507/1007-9424.202010078 Copy

1.	蒋康怡, 高峰畏, 雷泽华, 等. 全腹腔镜与开腹胰十二指肠切除术比较的非 RCT 研究的 meta 分析. 中国普外基础与临床杂志, 2019, 26(4): 448-457.
2.	Topal B, Fieuws S. Pancreaticogastrostomy after pancreaticoduodenectomy? Lancet Oncol, 2013, 14(9): e340-e341.
3.	Diener MK, Tadjalli-Mehr K, Wente MN, et al. Risk-benefit assessment of closed intra-abdominal drains after pancreatic surgery: a systematic review and meta-analysis assessing the current state of evidence. Langenbecks Arch Surg, 2011, 396(1): 41-52.
4.	彭兵. 腹腔镜胰十二指肠切除术后临床胰瘘危险因素分析. 中华腔镜外科杂志(电子版), 2017, 10(6): 355-360.
5.	吴浩然, 毛先海, 段小辉. 腹腔镜胰十二指肠切除术术后并发症危险因素分析及术后胰瘘风险预测模型. 衡阳: 南华大学, 2019.
6.	张生, 谭志健. 腹腔镜胰十二指肠切除术后临床胰瘘相关因素分析. 广州: 广州中医药大学, 2019.
7.	Bassi C, Marchegiani G, Dervenis C, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery, 2017, 161(3): 584-591.
8.	Bassi C, Molinari E, Malleo G, et al. Early versus late drain removal after standard pancreatic resections: results of a prospective randomized trial. Ann Surg, 2010, 252(2): 207-214.
9.	de Rooij T, Lu MZ, Steen MW, et al. Minimally invasive versus open pancreatoduodenectomy: systematic review and meta-analysis of comparative cohort and registry studies. Ann Surg, 2016, 264(2): 257-267.
10.	Dugalic VD, Knezevic DM, Obradovic VN, et al. Drain amylase value as an early predictor of pancreatic fistula after cephalic duodenopancreatectomy. World J Gastroenterol, 2014, 20(26): 8691-8699.
11.	Gans SL, Atema JJ, van Dieren S, et al. Diagnostic value of C-reactive protein to rule out infectious complications after major abdominal surgery: a systematic review and meta-analysis. Int J Colorectal Dis, 2015, 30(7): 861-873.
12.	Shrikhande SV, Sivasanker M, Vollmer CM, et al. Pancreatic anastomosis after pancreatoduodenectomy: A position statement by the International Study Group of Pancreatic Surgery (ISGPS). Surgery, 2017, 161(5): 1221-1234.
13.	Ansorge C, Nordin JZ, Lundell L, et al. Diagnostic value of abdominal drainage in individual risk assessment of pancreatic fistula following pancreaticoduodenectomy. Br J Surg, 2014, 101(2): 100-108.
14.	Tsujie M, Nakamori S, Miyamoto A, et al. Risk factors of pancreatic fistula after pancreaticoduodenectomy—patients with low drain amylase level on postoperative day 1 are safe from developing pancreatic fistula. Hepatogastroenterology, 2012, 59(120): 2657-2660.
15.	Hiyoshi M, Chijiiwa K, Fujii Y, et al. Usefulness of drain amylase, serum C-reactive protein levels and body temperature to predict postoperative pancreatic fistula after pancreaticoduodenectomy. World J Surg, 2013, 37(10): 2436-2442.
16.	张治桥, 陈梅福. 腹腔镜胰十二指肠切除术后胰瘘的危险因素分析. 长沙: 湖南师范大学, 2019.
17.	Molinari E, Bassi C, Salvia R, et al. Amylase value in drains after pancreatic resection as predictive factor of postoperative pancreatic fistula: results of a prospective study in 137 patients. Ann Surg, 2007, 246(2): 281-287.
18.	Lee CW, Pitt HA, Riall TS, et al. Low drain fluid amylase predicts absence of pancreatic fistula following pancreatectomy. J Gastrointest Surg, 2014, 18(11): 1902-1910.
19.	Lee SR, Kim HO, Shin JH. Significance of drain fluid amylase check on day 3 after pancreatectomy. ANZ J Surg, 2019, 89(5): 497-502.
20.	Belmouhand M, Krohn PS, Svendsen LB, et al. The occurrence of Enterococcus faecium and faecalis is significantly associated with anastomotic leakage after pancreaticoduodenectomy. Scand J Surg, 2018, 107(2): 107-113.
21.	Zhang JF, Zhu HY, Sun YW, et al. Pseudomonas aeruginosa infection after pancreatoduodenectomy: risk factors and clinic impacts. Surg Infect (Larchmt), 2015, 16(6): 769-774.
22.	Palani Velu LK, McKay CJ, Carter CR, et al. Serum amylase and C-reactive protein in risk stratification of pancreas-specific complications after pancreaticoduodenectomy. Br J Surg, 2016, 103(5): 553-563.
23.	Palani Velu LK, Chandrabalan VV, Jabbar S, et al. Serum amylase on the night of surgery predicts clinically significant pancreatic fistula after pancreaticoduodenectomy. HPB (Oxford), 2014, 16(7): 610-619.
24.	Warschkow R, Ukegjini K, Tarantino I, et al. Diagnostic study and meta-analysis of C-reactive protein as a predictor of postoperative inflammatory complications after pancreatic surgery. J Hepatobiliary Pancreat Sci, 2012, 19(4): 492-500.
25.	Wente MN, Bassi C, Dervenis C, et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery, 2007, 142(5): 761-768.
26.	Kaminsky PM, Mezhir JJ. Intraperitoneal drainage after pancreatic resection: a review of the evidence. J Surg Res, 2013, 184(2): 925-930.

1. 蒋康怡, 高峰畏, 雷泽华, 等. 全腹腔镜与开腹胰十二指肠切除术比较的非 RCT 研究的 meta 分析. 中国普外基础与临床杂志, 2019, 26(4): 448-457.
2. Topal B, Fieuws S. Pancreaticogastrostomy after pancreaticoduodenectomy? Lancet Oncol, 2013, 14(9): e340-e341.
3. Diener MK, Tadjalli-Mehr K, Wente MN, et al. Risk-benefit assessment of closed intra-abdominal drains after pancreatic surgery: a systematic review and meta-analysis assessing the current state of evidence. Langenbecks Arch Surg, 2011, 396(1): 41-52.
4. 彭兵. 腹腔镜胰十二指肠切除术后临床胰瘘危险因素分析. 中华腔镜外科杂志(电子版), 2017, 10(6): 355-360.
5. 吴浩然, 毛先海, 段小辉. 腹腔镜胰十二指肠切除术术后并发症危险因素分析及术后胰瘘风险预测模型. 衡阳: 南华大学, 2019.
6. 张生, 谭志健. 腹腔镜胰十二指肠切除术后临床胰瘘相关因素分析. 广州: 广州中医药大学, 2019.
7. Bassi C, Marchegiani G, Dervenis C, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery, 2017, 161(3): 584-591.
8. Bassi C, Molinari E, Malleo G, et al. Early versus late drain removal after standard pancreatic resections: results of a prospective randomized trial. Ann Surg, 2010, 252(2): 207-214.
9. de Rooij T, Lu MZ, Steen MW, et al. Minimally invasive versus open pancreatoduodenectomy: systematic review and meta-analysis of comparative cohort and registry studies. Ann Surg, 2016, 264(2): 257-267.
10. Dugalic VD, Knezevic DM, Obradovic VN, et al. Drain amylase value as an early predictor of pancreatic fistula after cephalic duodenopancreatectomy. World J Gastroenterol, 2014, 20(26): 8691-8699.
11. Gans SL, Atema JJ, van Dieren S, et al. Diagnostic value of C-reactive protein to rule out infectious complications after major abdominal surgery: a systematic review and meta-analysis. Int J Colorectal Dis, 2015, 30(7): 861-873.
12. Shrikhande SV, Sivasanker M, Vollmer CM, et al. Pancreatic anastomosis after pancreatoduodenectomy: A position statement by the International Study Group of Pancreatic Surgery (ISGPS). Surgery, 2017, 161(5): 1221-1234.
13. Ansorge C, Nordin JZ, Lundell L, et al. Diagnostic value of abdominal drainage in individual risk assessment of pancreatic fistula following pancreaticoduodenectomy. Br J Surg, 2014, 101(2): 100-108.
14. Tsujie M, Nakamori S, Miyamoto A, et al. Risk factors of pancreatic fistula after pancreaticoduodenectomy—patients with low drain amylase level on postoperative day 1 are safe from developing pancreatic fistula. Hepatogastroenterology, 2012, 59(120): 2657-2660.
15. Hiyoshi M, Chijiiwa K, Fujii Y, et al. Usefulness of drain amylase, serum C-reactive protein levels and body temperature to predict postoperative pancreatic fistula after pancreaticoduodenectomy. World J Surg, 2013, 37(10): 2436-2442.
16. 张治桥, 陈梅福. 腹腔镜胰十二指肠切除术后胰瘘的危险因素分析. 长沙: 湖南师范大学, 2019.
17. Molinari E, Bassi C, Salvia R, et al. Amylase value in drains after pancreatic resection as predictive factor of postoperative pancreatic fistula: results of a prospective study in 137 patients. Ann Surg, 2007, 246(2): 281-287.
18. Lee CW, Pitt HA, Riall TS, et al. Low drain fluid amylase predicts absence of pancreatic fistula following pancreatectomy. J Gastrointest Surg, 2014, 18(11): 1902-1910.
19. Lee SR, Kim HO, Shin JH. Significance of drain fluid amylase check on day 3 after pancreatectomy. ANZ J Surg, 2019, 89(5): 497-502.
20. Belmouhand M, Krohn PS, Svendsen LB, et al. The occurrence of Enterococcus faecium and faecalis is significantly associated with anastomotic leakage after pancreaticoduodenectomy. Scand J Surg, 2018, 107(2): 107-113.
21. Zhang JF, Zhu HY, Sun YW, et al. Pseudomonas aeruginosa infection after pancreatoduodenectomy: risk factors and clinic impacts. Surg Infect (Larchmt), 2015, 16(6): 769-774.
22. Palani Velu LK, McKay CJ, Carter CR, et al. Serum amylase and C-reactive protein in risk stratification of pancreas-specific complications after pancreaticoduodenectomy. Br J Surg, 2016, 103(5): 553-563.
23. Palani Velu LK, Chandrabalan VV, Jabbar S, et al. Serum amylase on the night of surgery predicts clinically significant pancreatic fistula after pancreaticoduodenectomy. HPB (Oxford), 2014, 16(7): 610-619.
24. Warschkow R, Ukegjini K, Tarantino I, et al. Diagnostic study and meta-analysis of C-reactive protein as a predictor of postoperative inflammatory complications after pancreatic surgery. J Hepatobiliary Pancreat Sci, 2012, 19(4): 492-500.
25. Wente MN, Bassi C, Dervenis C, et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery, 2007, 142(5): 761-768.
26. Kaminsky PM, Mezhir JJ. Intraperitoneal drainage after pancreatic resection: a review of the evidence. J Surg Res, 2013, 184(2): 925-930.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Predictive value of amylase content of drainage fluid for clinically relevant postoperative pancreatic fistula after laparoscopic pancreaticoduodenectomy

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