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December 26, 2019International Surgery JournalOpen Access

Postoperative day 3 drain amylase ≥500 IU/l was statistically superior to moderate/high fistula risk score in predicting clinically relevant postoperative pancreatic fistula (AUC 0.868 vs 0.692, p=0.028).

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Why the study?

Clinically relevant postoperative pancreatic fistula is a major morbidity after pancreatico-duodenectomy, but there is no clear consensus regarding the ideal predictor among fistula risk score and postoperative drain amylase levels.

Does postoperative day 3 drain amylase level predict clinically relevant postoperative pancreatic fistula better than fistula risk score in patients undergoing pancreatico-duodenectomy?

Population

57 patients who underwent pancreatico-duodenectomy at one institute between 2014 and 2018

Comparison

Postoperative day 3 drain amylase level vs fistula risk score

Design

Retrospective analysis

Key result

Postoperative day 3 drain amylase ≥500 IU/l was statistically superior to moderate/high fistula risk score in predicting clinically relevant postoperative pancreatic fistula (AUC 0.868 vs 0.692, p=0.028).

Authors

NGNagesh GowdaSOSathish ObalanarasimhaiahBSBalakrishna Nanjundappa Setty

Discussion

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Member takes

Overview

May aid early CR-POPF risk stratification after PD; hypothesis-generating and requires prospective validation.

Study Design

Type

Observational (n=57)

Multicenter

No

Structured PICO

Does postoperative day 3 drain amylase level predict clinically relevant postoperative pancreatic fistula better than fistula risk score in patients undergoing pancreatico-duodenectomy?

P
Population
57 consecutive patients (mean age 47 years, 29.8% female) who underwent pancreatico-duodenectomy were retrospectively analyzed to predict clinically relevant postoperative pancreatic fistula.
E
Exposure
Postoperative day 3 drain amylase (POD3DA) level ≥500 IU/l
C
Comparator
Fistula risk score (FRS) (moderate/high vs negligible/low)
O
Outcome
Clinically relevant postoperative pancreatic fistula (CR-POPF) defined as ISGPF grade B or Csurrogate

Main Result

Effect estimate: AUC difference 0.175

Absolute Event Rate: 0.868% vs 0.692%

p-value: p=0.028

Postoperative day 3 drain amylase level ≥500 IU/l is a superior predictor of clinically relevant postoperative pancreatic fistula compared to the fistula risk score following pancreatico-duodenectomy.

Limitations

  • Retrospective nature and non-randomized analysis
  • Small cohort of patients operated at a single institute
  • No standardized criteria applied for gland texture, introducing subjective variation
  • Retrospective nature
  • Non-randomized analysis
  • Small cohort
  • Single institute
  • Subjective variation in gland texture assessment

Cite This Study

Gowda et al. (2019) conducted an observational in Pancreatico-duodenectomy (n=57). Postoperative day 3 drain amylase (POD3DA) ≥500 IU/l vs. Fistula risk score (FRS) moderate/high was evaluated on Prediction of clinically relevant postoperative pancreatic fistula (CR-POPF) measured by Area Under the Curve (AUC) (AUC difference 0.175, p=0.028). Postoperative day 3 drain amylase ≥500 IU/l was statistically superior to moderate/high fistula risk score in predicting clinically relevant postoperative pancreatic fistula (AUC 0.868 vs 0.692, p=0.028).

synapsesocial.com/papers/6a9ca78a48effd99aa57a982https://doi.org/10.18203/2349-2902.isj20195975
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Postoperative Day 3 Biomarkers for Risk Stratification and Prediction of Clinically Relevant Pancreatic Fistula After Pancreaticoduodenectomy: A Retrospective Cohort Study2026
  2. 2Predictive value of drain fluid amylase level on postoperative day one after pancreatic resection for predicting postoperative pancreatic fistula2024 · 1 citations
  3. 3Dynamic Assessment of Drain Fluid Amylase Estimates the Risk of CR-POPF Following Pancreatoduodenectomy2024 · 2 citations
  4. 4Drain amylase values for clinically relevant post‐operative pancreatic fistulae2024
  5. 5Lipase-to-Amylase Ratio for the Prediction of Clinically Relevant Postoperative Pancreatic Fistula Following Pancreaticoduodenectomy2024 · 1 citations