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Potential clinical utility of intraoperative fluid amylase measurement during pancreaticoduodenectomy
Kunal Joshi1, Manuel Abradelo1, David Christopher Bartlett1
1Liver Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom.
Insights
Intraoperative fluid amylase (IFA) can help predict postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD). High IFA levels correlate with POPF, aiding early risk stratification for better patient outcomes.
Area of Science:
- Surgical Oncology
- Gastroenterology
- Biochemistry
Background:
- Postoperative pancreatic fistula (POPF) is a significant complication after pancreaticoduodenectomy (PD), impacting patient morbidity and mortality.
- Early detection and management of POPF are crucial for improving patient outcomes.
- Clinical risk scores combined with drain fluid amylase (DFA) can stratify patients at risk.
Purpose of the Study:
- To determine if intraoperative fluid amylase (IFA) values correlate with postoperative DFA and POPF.
- To assess the potential of IFA as an early predictor of POPF.
Main Methods:
- Intraoperative fluid amylase (IFA) samples were collected adjacent to the pancreatic anastomosis before abdominal closure in patients undergoing PD.
- Prospective data collection included patient demographics, postoperative DFA, complications, and mortality.
- Correlation analysis was performed between IFA, DFA, and POPF incidence.
Main Results:
- A significant correlation was found between IFA and DFA1 (R² = 0.713; p < 0.001) and DFA3 (p < 0.001).
- Median IFA was significantly higher in patients who developed POPF (1,232.5 U/L) compared to those who did not (122 U/L; p = 0.0003).
- IFA > 260 U/L predicted POPF with high sensitivity (88.0%) and specificity (75.0%).
Conclusions:
- Intraoperative fluid amylase (IFA) shows a strong correlation with postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD).
- IFA may serve as a valuable adjunct to existing clinical risk scores for patient stratification.
- Further large-scale prospective studies are warranted to confirm the clinical utility of IFA in managing PD patients.
Backgrounds/Aims:
Postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD) is a source of major morbidity and mortality. Early diagnosis and treatment of POPF is mandatory to improve patient outcomes and clinical risk scores may be ombined with postoperative drain fluid amylase (DFA) values to stratify patients. The aim of this pilot study was to etermine if intraoperative fluid amylase (IFA) values correlate with DFA1 and POPF.
Methods:
In patients undergoing PD from February to November 2020, intraoperative samples of intra-abdominal fluid adjacent to the pancreatic anastomosis were taken and sent for fluid amylase measurement prior to abdominal closure. Data regarding patient demographics, postoperative DFA values, complications, and mortality were prospectively collected.
Results:
Data were obtained for 52 patients with a median alternative Fistula Risk Score (aFRS) of 9.9. Postoperative complications occurred in 20 (38.5%) patients (five Clavien grade ≥ 3). There were eight POPFs and two patients died (pneumonia/sepsis). There was a significant correlation between IFA and DFA1 (R2 = 0.713; p < 0.001) and DFA3 (p < 0.001), and the median IFA was higher in patients with POPF than patients without (1,232.5 vs. 122; p = 0.0003). IFA > 260 U/L predicted POPF with sensitivity, specificity, positive and negative predictive values of 88.0%, 75.0%, 39.0%, and 97.0%, respectively. The incidence of POPF was 43.0% in high-risk (high aFRS/IFA) and 0% in lowrisk patients (low aFRS/IFA).
Conclusions:
IFA correlated with POPF and may be a useful adjunct to clinical risk scores to stratify patients during PD. Larger, prospective studies are needed to determine whether IFA has clinical utility.
