Significance of drain fluid amylase check on day 3 after pancreatectomy

The occurrence of pancreatic fistulae (PF) after pancreatectomy is the main cause of prolonged hospital stay, delayed chemotherapy, poor quality of life and post-operative death. The surgical drainage after pancreatectomy can induce ascending infection, early removal is recommended if the possibility of PF is low. The present study analysed the risk factors and predictors of PF, and confirmed the significance of drain fluid amylase concentration (DFA, U/L) among various factors identified. On the basis of these results, we tried to evaluate the practical clinical applicability of DFA and obtain appropriate baseline values.

From January 2014 to December 2017, 117 patients underwent major pancreatectomy with pylorus-preserving pancreatoduodenectomy, Whipple procedure, subtotal pancreatectomy or distal pancreatectomy. This study retrospectively collected and analysed demographics, pathological results and prognoses of these patients.

Multivariate analysis indicated that the DFA obtained on day 3 after surgery (DFA 3) was the only predictor of PF with statistical significance (P < 0.001). Of all the factors tested, area under the curve was highest for DFA 3 (0.89). In addition, of all the factors tested, DFA 3 with a cut-off value of 1004 U/L had the best sensitivity (92%) and specificity (82%).

DFA 3 of a cut-off value of 1004 U/L might be determined to be the best predictor of PF, and early removal of the surgical drain could be considered if DFA (1004 U/L) is lower than the cut-off value at 3 days after surgery.