Identification of an optimal cut-off for drain fluid amylase on postoperative day 1 for predicting clinically relevant fistula after distal pancreatectomy

Maggino, L. et al. (2019) Identification of an optimal cut-off for drain fluid amylase on postoperative day 1 for predicting clinically relevant fistula after distal pancreatectomy. Annals of Surgery, 269(2), pp. 337-343. (doi: 10.1097/SLA.0000000000002532) (PMID:28938266)

Abstract

Objective: The aim of this study was to investigate the relationship between drain fluid amylase value on the first postoperative day (DFA1) and clinically relevant fistula (CR-POPF) after distal pancreatectomy (DP), and to identify the cut-off of DFA1 that optimizes CR-POPF prediction. Background: DFA1 is a well-recognized predictor of CR-POPF after pancreatoduodenectomy, but its role in DP is largely unexplored. Methods: DFA1 levels were correlated with CR-POPF in 2 independent multi-institutional sets of DP patients: developmental (n = 338; years 2012 to 2017) and validation cohort (n = 166; years 2006 to 2016). Cut-off choice was based on Youden index calculation, and its ability to predict CR-POPF occurrence was tested in a multivariable regression model adjusted for clinical, demographic, operative, and pathological variables. Results: In the developmental set, median DFA1 was 1745 U/L and the CR-POPF rate was 21.9%. DFA1 correlated with CR-POPF with an area under the curve of 0.737 (P < 0.001). A DFA1 of 2000 U/L had the highest Youden index, with 74.3% sensitivity and 62.1% specificity. Patients in the validation cohort displayed different demographic and operative characteristics, lower values of DFA1 (784.5 U/L, P < 0.001), and reduced CR-POPF rate (10.2%, P < 0.001). However, a DFA1 of 2000 U/L had the highest Youden index in this cohort as well, with 64.7% sensitivity and 75.8% specificity. At multivariable analysis, DFA1 >=2000 U/L was the only factor significantly associated with CR-POPF in both cohorts. Conclusion: A DFA1 of 2000 U/L optimizes CR-POPF prediction after DP. These results provide the substrate to define best practices and improve outcomes for patients receiving DP.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Jamieson, Professor Nigel
• Authors: Maggino, L., Malleo, G., Bassi, C., Allegrini, V., Beane, J. D., Beckman, R. M., Chen, B., Dickson, E. J., Drebin, J. A., Ecker, B. L., Fraker, D. L., House, M. G., Jamieson, N. B., Javed, A. A., Kowalsky, S. J., Lee, M. K., McMillan, M. T., Roses, R. E., Salvia, R., Valero, V., Velu, L. K. P., Wolfgang, C. L., Zureikat, A. H., and Vollmer, C. M.
• College/School: College of Medical Veterinary and Life Sciences > School of Cancer Sciences
• Journal Name: Annals of Surgery
• Publisher: Lippincott, Williams & Wilkins
• ISSN: 0003-4932
• ISSN (Online): igel B.