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Association Between Postoperative Pancreatitis and Clinically Relevant Postoperative Pancreatic Fistula After

Uday Sankar Reddy Kathulapalli1, Harshal Bhoi1, Jyotirmay Jena1

  • 1Surgical Gastroenterology, Siksha 'O' Anusandhan, Institute of Medical Sciences and Sum Hospital, Bhubaneswar, IND.

Cureus
|February 27, 2026
PubMed

Insights

Postoperative day 1 serum amylase and drain fluid amylase reliably predict clinically relevant postoperative pancreatic fistula after pancreaticoduodenectomy. High drain fluid amylase or low serum amylase levels can guide early management decisions.

Area of Science:

  • Gastroenterology and Hepatology
  • Surgical Oncology
  • Abdominal Surgery

Background:

  • Postoperative pancreatic fistula (POPF) is a significant complication after pancreaticoduodenectomy (PD), impacting patient morbidity.
  • Early identification of patients at risk for clinically relevant POPF (CR-POPF) is crucial for timely intervention and management.

Purpose of the Study:

  • To evaluate the predictive value of postoperative day 1 (POD 1) serum amylase (SA) and drain fluid amylase (DFA) for CR-POPF following PD.
  • To establish optimal cutoff values for POD 1 SA and DFA to facilitate risk-stratified postoperative care.

Main Methods:

  • Prospective observational cohort study of adult patients undergoing PD with duct-to-mucosa pancreaticojejunal anastomosis.
  • Measurement of SA and DFA on POD 1, POD 3, and POD 5.
  • Receiver operating characteristic (ROC) analysis to determine optimal POD 1 cutoff values for CR-POPF prediction.

Main Results:

  • Nine out of 57 patients (15.8%) developed CR-POPF.
  • Significantly higher mean POD 1 SA (464 vs 262 IU/L) and DFA (12,664 vs 1,045 IU/L) in CR-POPF patients (p<0.002).
  • POD 1 DFA showed high specificity (97.92%) with a cutoff of 3,011 IU/L (AUC 0.889); POD 1 SA cutoff of 363 IU/L had high sensitivity (77.78%) (AUC 0.803).

Conclusions:

  • POD 1 SA and DFA levels are reliable early predictors of CR-POPF after PD.
  • A POD 1 DFA >3,011 IU/L strongly suggests CR-POPF, while SA ≤363 IU/L helps exclude it.
  • Integrating these biomarkers into postoperative protocols can improve drain management and targeted interventions for high-risk patients.
Abstract

Keywords:
clinically relevant popfdrain fluid amylasepancreaticoduodenectomypostoperative pancreatic fistularisk stratificationroc analysisserum amylase

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