Clinical relevant pancreatic fistula after pancreatoduodenectomy: when negative amylase levels tell the truth

• Published in: Updates in surgery 2021-08, Vol.73 (4), p.1391-1397
• Main Authors: Giovinazzo, Francesco, Linneman, Ralph, Riva, Giulio Valentino Dalla, Greener, Daniele, Morano, Christopher, Patijn, Gijs A., Besselink, Mark G. H., Nieuwenhuijs, Vincent B., Abu Hilal, Mohammad, de Hingh, I. H., Kazemier, G., Festen, S., de Jong, K. P., van Eijck, C. H. J., Scheepers, J. J. G., van der Kolk, M., den Dulk, M., Bosscha, K., Boerma, D., van der Harst, E., Armstrong, T., Takhar, A., Hamady, Zaed
• Format: Article
• Language: English
• Subjects: Medicine; Medicine & Public Health; Original Article; Surgery
• ISSN: 2038-131X; 2038-3312
• DOI: 10.1007/s13304-021-01020-8

Drain Amylase level are routinely determined to diagnose pancreatic fistula after Pancreatocoduodenectomy. Consensus is lacking regarding the cut-off value of amylase to diagnosis clinically relevant postoperative pancreatic fistulae (POPF). The present study proposes a model based on Amylase Value in the Drain (AVD) measured in the first three postoperative days to predict a POPF. Amylase cut-offs were selected from a previous published systematic review and the accuracy were validated in a multicentre database from 12 centres in 2 countries. The present study defined POPF the 2016 ISGPS criteria (3 times the upper limit of normal serum amylase). A learning machine method was used to correlate AVD with the diagnosis of POPF. Overall, 454 (27%) of 1638 patients developed POPF. Machine learning excluded a clinically relevant postoperative pancreatic fistulae with an AUC of 0.962 (95% CI 0.940–0.984) in the first five postoperative days. An AVD at a cut-off of 270 U/L in 2 days in the first three postoperative days excluded a POPF with an AUC of 0.869 (CI 0.81–0.90, p