Which is the best predictor of clinically relevant pancreatic fistula after pancreatectomy: drain fluid concentration or total amount of amylase?

Drain fluid amylase concentration (DFAC) has been reported as a predictor of clinically relevant postoperative pancreatic fistula (CR-POPF) after pancreatectomy. However, the clinical significance of measuring the total drain fluid amylase amount (DFAA) considering the daily drainage volume of CR-POPF remains unclear. Data from 216 consecutive patients who underwent pancreaticoduodenectomy (PD) (n = 126) or distal pancreatectomy (DP) (n = 90) between August 2014 and November 2020 were reviewed. All drains were closed but not suctioned. DFAA was calculated by multiplying the DFAC and daily drainage fluid volume. DFAC and DFAA were recorded on d 1 and 3 after pancreatectomy. The cutoff value of CR-POPF was determined using the receiver operating characteristic curve. CR-POPF was found in 75 patients (35%) (PD: 30%, DP: 41%, DFAC is more reliable than DFAA for predicting CR-POPF after both PD and DP.

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© 2021 The Authors. Annals of Gastroenterological Surgery published by John Wiley & Sons Australia, Ltd on behalf of The Japanese Society of Gastroenterological Surgery.

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Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article. Ethics Approval and Consent to Participate: This study was approved by the Institutional Review Board of Aichi Medical University (No. 2020–119) and performed in accordance with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. All patients provided signed informed consent before surgery. Conflict of Interest: The authors have no conflicts of interest to disclose. Author Contributions: Fukami designed the study and wrote the initial draft of the article. Sano contributed to interpretation of the data and the critical revision of the article for important intellectual content. All the other authors (TS, TO, TH, TK, SK, TM, SK, and KK) contributed to the data collection and interpretation and critically reviewed the article. All the authors have read and approved the final version of the article and have agreed to be accountable for all aspects of the study, ensuring that any questions related to the accuracy or integrity of any part of the work are resolved.