Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Nov;406(7):2333-2341.
doi: 10.1007/s00423-021-02192-y. Epub 2021 May 14.

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

Jelle C van Dongen  1 , Steven Merkens  1 , M Hossein Aziz  1 , Bas Groot Koerkamp  1 , Casper H J van Eijck  2   3
Affiliations

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

Jelle C van Dongen et al. Langenbecks Arch Surg. 2021 Nov.

Abstract

Purpose: Serum 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.

Methods: This 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.

Results: A 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).

Conclusion: Postoperative 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.

Keywords: Amylase; Pancreatic fistula; Pancreatoduodenectomy.

PubMed Disclaimer

Conflict of interest statement

Not applicable

Figures

Fig. 1
Fig. 1
a Sensitivity and specificity of serum amylase on postoperative day 1. b Sensitivity and specificity of drain fluid amylase on postoperative day 2
Fig. 2
Fig. 2
Flowchart of patients based on serum amylase on postoperative day 1 and drain fluid amylase on postoperative day 2
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Callery MP, Pratt WB, Kent TS, Chaikof EL, Vollmer CM., Jr A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy. J Am Coll Surg. 2013;216(1):1–14. doi: 10.1016/j.jamcollsurg.2012.09.002. - DOI - PubMed
    1. Reid-Lombardo KM, Farnell MB, Crippa S, Barnett M, Maupin G, Bassi C, Traverso LW, Members of the Pancreatic Anastomotic Leak Study Group Pancreatic anastomotic leakage after pancreaticoduodenectomy in 1,507 patients: a report from the Pancreatic Anastomotic Leak Study Group. J Gastrointest Surg. 2007;11(11):1451–1458. doi: 10.1007/s11605-007-0270-4. - DOI - PubMed
    1. Miller BC, Christein JD, Behrman SW, Callery MP, Drebin JA, Kent TS, Pratt WB, Lewis RS, Jr, Vollmer CM., Jr Assessing the impact of a fistula after a pancreaticoduodenectomy using the post-operative morbidity index. HPB (Oxford) 2013;15(10):781–788. doi: 10.1111/hpb.12131. - DOI - PMC - PubMed
    1. Conlon KC, Labow D, Leung D, Smith A, Jarnagin W, Coit DG, Merchant N, Brennan MF. Prospective randomized clinical trial of the value of intraperitoneal drainage after pancreatic resection. Ann Surg. 2001;234(4):487–493. doi: 10.1097/00000658-200110000-00008. - DOI - PMC - PubMed
    1. Van Buren G, 2nd, Bloomston M, Hughes SJ, Winter J, Behrman SW, Zyromski NJ, et al. A randomized prospective multicenter trial of pancreaticoduodenectomy with and without routine intraperitoneal drainage. Ann Surg. 2014;259(4):605–612. doi: 10.1097/SLA.0000000000000460. - DOI - PubMed

MeSH terms

LinkOut - more resources