Details

Autor(en) / Beteiligte

• Maggino, Laura
• Malleo, Giuseppe
• Bassi, Claudio
• Allegrini, Valentina
• Beane, Joal D
• Beckman, Ross M
• Chen, Bofeng
• Dickson, Euan J
• Drebin, Jeffrey A
• Ecker, Brett L
• Fraker, Douglas L
• House, Michael G
• Jamieson, Nigel B
• Javed, Ammar A
• Kowalsky, Stacy J
• Lee, Major K
• McMillan, Matthew T
• Roses, Robert E
• Salvia, Roberto
• Valero, 3rd, Vicente
• Velu, Lavanniya K P
• Wolfgang, Christopher L
• Zureikat, Amer H
• Vollmer, Jr, Charles M

Titel

Identification of an Optimal Cut-off for Drain Fluid Amylase on Postoperative Day 1 for Predicting Clinically Relevant Fistula After Distal Pancreatectomy: A Multi-institutional Analysis and External Validation

Ist Teil von

• Annals of surgery, 2019-02, Vol.269 (2), p.337-343

Ort / Verlag

United States

Erscheinungsjahr

2019

Quelle

MEDLINE

Beschreibungen/Notizen

• 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. DFA1 is a well-recognized predictor of CR-POPF after pancreatoduodenectomy, but its role in DP is largely unexplored. 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. 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. 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.