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Pancreatology. 2015 Mar-Apr;15(2):179-84. doi: 10.1016/j.pan.2014.12.003. Epub 2014 Dec 30.

Negative predictive value of drain amylase concentration for development of pancreatic fistula after pancreaticoduodenectomy.

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HPB & Transplant Surgery Unit, Cambridge University Hospitals NHS Trust, Cambridge, UK.
HPB & Transplant Surgery Unit, Cambridge University Hospitals NHS Trust, Cambridge, UK. Electronic address:
Department of Histopathology, Cambridge University Hospitals NHS Trust, Cambridge, UK.



Post-operative pancreatic fistula (POPF) is the major source of morbidity following pancreaticoduodenectomy. A predictive indicator would be highly advantageous. One potential marker is drain amylase concentration (DAC). However, its predictive value has not been fully established.


405 patients undergoing pancreaticoduodenectomy at our centre over a 10 year period were reviewed to determine the value of DAC as a predictive indicator for the development of POPF.


POPF developed in 58 patients (14%). These patients suffered greater morbidity. Overall 30-day mortality was 1.5%. Male gender (OR: 5.1; p = 0.0082) and age > 70 (OR 2; p = 0.0372) were independent risk factors for POPF, whilst Type 2 diabetes (OR: 0.2321; p = 0.0090) and pancreatic ductal-adenocarcinoma (OR: 0.3721; p = 0.0039) decreased POPF risk. The DACs post-operatively were significantly higher in those developing POPF, but with significant overlap. ROC curves revealed optimal threshold values for differentiating POPF and non-POPF patients. A DAC°<°1400 U/ml on day 1 and <768 U/ml on day 2, although having a poor positive predictive value (32-44%), had a very strong negative predictive value (97-99%).


Our data suggest that post-operative DAC below the determined optimal threshold values on day 1 and 2 following pancreaticoduodenectomy carries high negative predictive value for POPF development and identifies patients in whom early drain removal, and enhanced recovery may be considered, with simultaneous assessment of operative and clinical factors.


Drain amylase concentration; Drain removal; Enhanced recover; Pancreaticoduodenectomy; Postoperative pancreatic fistula; Whipples resection

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