Drain amylase value as an early predictor of pancreatic fistula after cephalic duodenopancreatectomy

Table 1 Clinical, intraoperative and postoperative characteristics in relation to the occurrence and stage of pancreatic fistula-univariate analysis n (%)

Parameter	Pancreatic fistula			Pvalue
	No1	BPF2	CRPF3	P12	P13	P23
Gender (M/F)	137/101	50/37	44/131
Age	61.1 ± 10.6	60.0 ± 10.4	61.4 ± 8.2	0.518	0.855	0.407
PF	238 (62.3)	87 (22.8)	57 (14.9)	0.0111	0.0111	0.126
Pancreas texture-soft	9 (10.7)	32 (38.0)	43 (51.2)	0.0011	0.0011	0.225
MPD diameter ≤ 3 mm	45 (23.4)	74 (38.5)	73 (38.1)	0.0361	0.059	0.910
Soft/MPD ≤ 3 mm	7/9 (77.8)	31/32 (96.9)	40/43 (93.0)
Surgical procedure
PPDP	133 (46.0)	74 (25.6)	82 (28.4)	0.0021	0.0071	0.653
Whipple	31 (33.6)	35 (38.0)	26 (28.4)	0.739	0.590	0.384
Pathology
Pancreatic ductal adeno Ca	87 (60.0)	33 (22.8)	25 (17.2)	0.0011	0.0011	0.169
Papila Vateri Ca	28 (26.9)	35 (33.6)	41 (39.5)	0.493	0.250	0.639
Common bile duct/duodenal Ca	16 (30.8)	21 (40.4)	15 (28.8)	0.444	0.719	0.572
Other
Blood transfusion (pt’s)	147/238(61.8)	46/87 (52.9)	33/57 (57.9)	0.0151	0.066	0.610
Blood transfusion (mL)	540.0 ± 345.4	560.7 ± 189.0	504.1 ± 340.4	0.759	0.634	0.416
Hospital stay	14.1 ± 9.0	17.7 ± 6.8	34.1 ± 16.3	0.0131	0.0011	0.0011
Mortality	-	2/87 (2.3)	14/57 (24.6)	-	-	0.0011

¹Significant P < 0.05, n/n, mean ± SD. MPD: Main pancreatic duct; PPDP: Pylorus-preserving duodenopancreatectomy.

Table 2 Postoperative complications by Dindo-Clavien classification n (%)

		Fistula
		NO		A	B/C
Dindo-clavien	0	201 (84.4)		56 (64.4)	0 (0.0)
	1	15 (6.3)		12 (13.8)	1 (1.8)
	2	8 (3.4)		9 (10.3)	30 (52.6)
	3	10 (4.2)		4 (4.6)	8 (14.0)
	4	4 (1.7)		4 (4.6)	4 (7.0)
	5	-	-	2 (2.3)	14 (24.6)
Total		238 (100.0)		87 (100.0)	57 (100.0)

Table 3 Drain fluid amylase values on postoperative days 1-3 in relation to the occurrence of pancreatic fistula, pancreatic texture and diameter of main pancreatic duct for patients with pancreatic fistula grade A

Grade A PF
Postoperative day	No clinical fistula (n= 238)	Hard pancreatic texture (n= 28)	Soft pancreatic texture diameter ≤3 mm (n= 31)	Sig.
1	122 (5-37875)	2097 (116-22039)	4520 (350-99000)	P = 0.0231
	P = 0.143	P = 0.668	P = 0.630
2	100 (6-1374)	1912 (118-61913)	3347 (397-99000)	P = 0.108
	P = 0.0031	P = 0.133	P = 0.0011
3	60 (3- 600)	1130 (200-28020)	1050 (343-90000)	P = 0.994

¹Significant P < 0.05, median (range). PF: Pancreatic fistula.

Table 4 Drain fluid amylase values on postoperative days 1-3 in relation to the occurrence of pancreatic fistula, pancreatic texture and diameter of main pancreatic duct for patients with pancreatic fistula grade B/C

Grade B/C PF
Postoperative days	No clinical fistula (n= 238)	Hard pancreatic texture (n= 18)	Soft pancreatic texture duct diameter ≤3 mm (n= 40)	Sig.
1	122 (5-37875)	8250 (117-95000)	8501 (377-92060)	P = 0.773
	P = 0.143	P = 0.672	P = 0. 877
2	100 (6-1374)	2990 (367-100000)	9014 (195-100000)	P = 0.079
	P = 0.0031	P = 0.307	P = 0. 085
3	60 (3-600)	2298 (279-100000)	6010 (86-100000)	P = 0.208

¹Significant P < 0.05, median (range). PF: Pancreatic fistula.

Table 5 Prognostic characteristics of threshold (cut-off) drain fluid amylase levels by postoperative days in the occurrence of biochemical pancreatic fistula and clinically relevant pancreatic fistulas in relation to the texture of the pancreas

Grade PF	Postoperative days	Cut off	Sensitivity	Specificity	FN	FP
		U/L
A Pancreatic texture-soft, duct diameter ≤ 3 mm
	1	> 1200	93.1%	87.5%	6.9%	12.5%
	2	> 800	89.7%	94.3%	10.3%	5.7%
	3	> 350	98.7%	97.8%	1.3%	2.2%
B/C Pancreatic texture-soft duct, diameter ≤ 3 mm
	1	> 1200	92.3%	87.5%	7.7%	12.5%
	2	> 1200	89.7%	97.7%	10.3%	2.3%
	3	> 800	90.2%	98.9%	9.8%	1.1%

PF: Pancreatic fistula; FN: False negative; FP: False positive.

Table 6 Development of clinically relevant pancreatic fistulas depending on a threshold DFA1 (our results in comparison with different series, molinari, sutcliffe)

DFA U/L	Fistula B/C	No fistula	∑	Sensitivity	Specificity	Fn	Fp
Molinari
> 5000	39	2	41	68.4%	99.1%	31.6%	0.9%
≤ 5000	17	236	254
∑	57	238	295
Sutcliffe
> 350	54	78	132	94.7%	67.2%	5.3%	32.8%
≤ 350	3	160	163
∑	57	238	295

DFA: Drain fluid amylase.