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J Gastrointest Surg. 2017 Jun;21(6):1031-1037. doi: 10.1007/s11605-017-3395-0. Epub 2017 Mar 20.

Intra-Operative Amylase Concentration in Peri-Pancreatic Fluid Predicts Pancreatic Fistula After Distal Pancreatectomy.

Nahm CB1,2,3, de Reuver PR4, Hugh TJ1,2,3, Pearson A1,2, Gill AJ3,5, Samra JS1,2,3, Mittal A6,7,8.

Author information

1
Upper Gastrointestinal Surgical Unit, Department of Gastrointestinal Surgery, Royal North Shore Hospital, Reserve Road, St. Leonards, 2065, NSW, Australia.
2
North Shore Private Hospital, Reserve Road, St. Leonards, 2065, NSW, Australia.
3
Northern Clinical School, The University of Sydney, Sydney, NSW, Australia.
4
Department of Surgery, Radboudumc, Nijmegen, The Netherlands.
5
Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, Australia.
6
Upper Gastrointestinal Surgical Unit, Department of Gastrointestinal Surgery, Royal North Shore Hospital, Reserve Road, St. Leonards, 2065, NSW, Australia. mittal.surgery@gmail.com.
7
North Shore Private Hospital, Reserve Road, St. Leonards, 2065, NSW, Australia. mittal.surgery@gmail.com.
8
Northern Clinical School, The University of Sydney, Sydney, NSW, Australia. mittal.surgery@gmail.com.

Abstract

Post-operative pancreatic fistula (POPF) is a potentially severe complication following distal pancreatectomy. The aim of this study was to assess the predictive value of intra-operative amylase concentration (IOAC) in peri-pancreatic fluid after distal pancreatectomy for the diagnosis of POPF. Consecutive patients who underwent a distal pancreatectomy between November 2014 and September 2016 were included in the analysis. IOAC was measured, followed by drain fluid analysis for amylase on post-operative days (PODs) 1, 3, and 5. Receiver operator characteristic (ROC) analysis was performed to evaluate the discriminative capacity of IOAC as a predictor of POPF. IOAC was measured after distal pancreatectomy in 26 patients. The IOAC correlated significantly with (i) PODs 1, 3, and 5 drain amylase (p < 0.01); (ii) the development of POPF (p < 0.01); and (iii) the Clavien-Dindo grade of surgical complications (p = 0.02). Eighty-three percent of patients with an IOAC > 1000 experienced a post-operative complication (OR 18.3, 95% CI 2.51-103, p < 0.01). ROC curve analysis confirmed the predictive relationship of IOAC and POPF as an excellent test with an area under the curve of 0.92 (95% CI 0.81-0.99, p < 0.01). Measurement of IOAC allows early and accurate categorization of patients at risk for POPF in distal pancreatectomy.

KEYWORDS:

Amylase; Pancreas; Pancreatectomy; Pancreatic fistula

PMID:
28321709
DOI:
10.1007/s11605-017-3395-0
[Indexed for MEDLINE]

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