TY - JOUR
T1 - Clinical relevant pancreatic fistula after pancreatoduodenectomy
T2 - when negative amylase levels tell the truth
AU - Giovinazzo, Francesco
AU - Linneman, Ralph
AU - Riva, Giulio Valentino Dalla
AU - Greener, Daniele
AU - Morano, Christopher
AU - Patijn, Gijs A.
AU - Besselink, Mark G. H.
AU - Nieuwenhuijs, Vincent B.
AU - Abu Hilal, Mohammad
AU - Artificial Intelligence Pancreatic Fistula Group
AU - de Hingh, I. H.
AU - Kazemier, G.
AU - Festen, S.
AU - de Jong, K. P.
AU - van Eijck, C. H. J.
AU - Scheepers, J. J. G.
AU - van der Kolk, M.
AU - den Dulk, M.
AU - Bosscha, K.
AU - Boerma, D.
AU - van der Harst, E.
AU - Armstrong, T.
AU - Takhar, A.
AU - Hamady, Zaed
PY - 2021/8/1
Y1 - 2021/8/1
N2 - 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 < 0.0001). A single AVD in the first three postoperative days may not exclude POPF after pancreatoduodenectomy. The levels should be monitored until day 3 and have two negative values before removing the drain. In the group with a positive level, the drain should be kept in and AVD monitored until postoperative day five.
AB - 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 < 0.0001). A single AVD in the first three postoperative days may not exclude POPF after pancreatoduodenectomy. The levels should be monitored until day 3 and have two negative values before removing the drain. In the group with a positive level, the drain should be kept in and AVD monitored until postoperative day five.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85133787025&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/33770412
U2 - https://doi.org/10.1007/s13304-021-01020-8
DO - https://doi.org/10.1007/s13304-021-01020-8
M3 - Article
C2 - 33770412
SN - 2038-131X
VL - 73
SP - 1391
EP - 1397
JO - Updates in Surgery
JF - Updates in Surgery
IS - 4
ER -