Sequential drain amylase to guide drain removal following pancreatectomy. Issue 6 (June 2018)

• Record Type: Journal Article
• Authors: Villafane-Ferriol, Nicole; Van Buren, George; Mendez-Reyes, Jose E.; McElhany, Amy L.; Massarweh, Nader N.; Silberfein, Eric J.; Hsu, Cary; Tran Cao, Hop S.; Schmidt, Carl; Zyromski, Nicholas J.; Dillhoff, Mary E.; Roch, Alexandra; Oliva, Evelyn; Smith, Alexander C.; Zhang, Qianzi; Fisher, William E.
• Is Part Of: HPB. Volume 20:Issue 6(2018)
• Page Start: 514
• Page End: 520
• Publication Date: 2018-06
• Subjects: Liver -- Diseases -- Periodicals; Biliary tract -- Diseases -- Periodicals; Pancreas -- Diseases -- Periodicals; 616.362005
• DOI: 10.1016/j.hpb.2017.11.008
• Languages: English
• ISSNs: 1365-182X

Abstract

Abstract: Background: Although used as criterion for early drain removal, postoperative day (POD) 1 drain fluid amylase (DFA) ≤ 5000 U/L has low negative predictive value for clinically relevant postoperative pancreatic fistula (CR-POPF). It was hypothesized that POD3 DFA ≤ 350 could provide further information to guide early drain removal. Methods: Data from a pancreas surgery consortium database for pancreatoduodenectomy and distal pancreatectomy patients were analyzed retrospectively. Those patients without drains or POD 1 and 3 DFA data were excluded. Patients with POD1 DFA ≤ 5000 were divided into groups based on POD3 DFA: Group A (≤350) and Group B (>350). Operative characteristics and 60-day outcomes were compared using chi-square test. Results: Among 687 patients in the database, all data were available for 380. Fifty-five (14.5%) had a POD1 DFA > 5000. Among 325 with POD1 DFA ≤ 5000, 254 (78.2%) were in Group A and 71 (21.8%) in Group B. Complications (35 (49.3%) vs 87 (34.4%); p = 0.021) and CR-POPF (13 (18.3%) vs 10 (3.9%); p < 0.001) were more frequent in Group B. Conclusions: In patients with POD1 DFA ≤ 5000, POD3 DFA ≤ 350 may be a practical test to guide safe early drain removal. Further prospective testing may be useful.