Drain data to predict clinically relevant pancreatic fistula.
Daniel J Moskovic1, Sally E Hodges, Meng-Fen Wu
1Michael E DeBakey Department of Surgery and Dan L Duncan Cancer Center, The Elkins Pancreas Center, Baylor College of Medicine, Houston, TX 77030, USA.
Summary
Early post-operative drain amylase levels do not reliably predict clinically significant post-operative pancreatic fistula (POPF) after pancreas resection. Drain output and amylase concentration showed limited accuracy in identifying patients who develop POPF.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Abdominal Surgery
Background:
- Post-operative pancreatic fistula (POPF) is a frequent and severe complication following pancreas resection.
- Effective management of POPF is crucial for pancreas surgeons.
Purpose of the Study:
- To assess the predictive accuracy of drain data for clinically significant post-operative pancreatic fistula (POPF).
Main Methods:
- Analysis of a prospectively maintained database of 177 consecutive pancreatic resections.
- Daily drain amylase concentrations and output volumes were recorded.
- Drain data, demographics, and operative details were correlated with POPF (ISGPF Grades A, B, C).
Main Results:
- POPF occurred in 46.4% of distal pancreatectomy and 43.0% of Whipple procedure patients.
- Drain data analysis was primarily focused on Whipple procedures due to low rates of significant POPF after distal pancreatectomy.
- Neither daily drain output nor amylase concentration reliably predicted clinically significant POPF (Grades B/C).
Conclusions:
- Early post-operative drain amylase levels lack the sensitivity and specificity to predict clinically significant POPF after pancreas resection.
- Drain amylase monitoring is not a reliable early indicator for managing POPF.
