• Annals of surgery · Feb 2019

    Multicenter Study

    Identification of an Optimal Cut-off for Drain Fluid Amylase on Postoperative Day 1 for Predicting Clinically Relevant Fistula after Distal Pancreatectomy: A Multi-Institutional Analysis and External Validation.

    • Laura Maggino, Giuseppe Malleo, Claudio Bassi, Valentina Allegrini, Joal D Beane, Ross M Beckman, Bofeng Chen, Euan J Dickson, Jeffrey A Drebin, Brett L Ecker, Douglas L Fraker, Michael G House, Nigel B Jamieson, Ammar A Javed, Stacy J Kowalsky, Major K Lee, Matthew T McMillan, Robert E Roses, Roberto Salvia, Vicente Valero, Lavanniya K P Velu, Christopher L Wolfgang, Amer H Zureikat, and Charles M Vollmer.
    • Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
    • Ann. Surg. 2019 Feb 1; 269 (2): 337-343.

    ObjectiveThe aim of this study was to investigate the relationship between drain fluid amylase value on the first postoperative day (DFA1) and clinically relevant fistula (CR-POPF) after distal pancreatectomy (DP), and to identify the cut-off of DFA1 that optimizes CR-POPF prediction.BackgroundDFA1 is a well-recognized predictor of CR-POPF after pancreatoduodenectomy, but its role in DP is largely unexplored.MethodsDFA1 levels were correlated with CR-POPF in 2 independent multi-institutional sets of DP patients: developmental (n = 338; years 2012 to 2017) and validation cohort (n = 166; years 2006 to 2016). Cut-off choice was based on Youden index calculation, and its ability to predict CR-POPF occurrence was tested in a multivariable regression model adjusted for clinical, demographic, operative, and pathological variables.ResultsIn the developmental set, median DFA1 was 1745 U/L and the CR-POPF rate was 21.9%. DFA1 correlated with CR-POPF with an area under the curve of 0.737 (P < 0.001). A DFA1 of 2000 U/L had the highest Youden index, with 74.3% sensitivity and 62.1% specificity. Patients in the validation cohort displayed different demographic and operative characteristics, lower values of DFA1 (784.5 U/L, P < 0.001), and reduced CR-POPF rate (10.2%, P < 0.001). However, a DFA1 of 2000 U/L had the highest Youden index in this cohort as well, with 64.7% sensitivity and 75.8% specificity. At multivariable analysis, DFA1 ≥2000 U/L was the only factor significantly associated with CR-POPF in both cohorts.ConclusionA DFA1 of 2000 U/L optimizes CR-POPF prediction after DP. These results provide the substrate to define best practices and improve outcomes for patients receiving DP.

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