Randomized Clinical Trial
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 14, 2017; 23(34): 6357-6364
Published online Sep 14, 2017. doi: 10.3748/wjg.v23.i34.6357
Drainage fluid and serum amylase levels accurately predict development of postoperative pancreatic fistula
Shuo Jin, Xiao-Ju Shi, Si-Yuan Wang, Ping Zhang, Guo-Yue Lv, Xiao-Hong Du, Guang-Yi Wang
Shuo Jin, School of Clinical Medicine, Tsinghua University, Beijing 100084, China
Shuo Jin, Department of Hepatobiliary and Pancreatic Surgery, Beijing Tsinghua Changgung Hospital Medical Center, Tsinghua University, Beijing 100084, China
Xiao-Ju Shi, Ping Zhang, Guo-Yue Lv, Xiao-Hong Du, Guang-Yi Wang, Department of Hepatobiliary and Pancreatic Surgery, Bethune First Hospital of Jilin University, Changchun 130021, Jilin Province, China
Si-Yuan Wang, Department of Respiratory and Critical Care Medicine, Beijing Chao-yang Hospital Affiliated to Capital Medical University, Beijing 100020, China
Author contributions: Jin S and Wang SY designed the clinical research; Wang SY performed the data analysis; Jin S wrote the paper; Wang GY and Shi XJ performed most of the operations in this research; The other authors performed the other operations.
Institutional review board statement: The study was reviewed and approved by the Bethune First Hospital of Jilin University Institutional Review Board.
Conflict-of-interest statement: We declare that we do not have any commercial or associative interest that represents a conflict of interest in connection with the work submitted.
Data sharing statement: There is no additional data available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Guang-Yi Wang, PhD, Department of Hepatobiliary and Pancreatic Surgery, Bethune First Hospital of Jilin University, 71 Xinmin Avenue, Changchun 130021, Jilin Province, China. guangyi@jlu.edu.cn
Telephone: +86-18611172714 Fax: +86-0431-88782356
Received: February 9, 2017
Peer-review started: February 10, 2017
First decision: March 7, 2017
Revised: April 4, 2017
Accepted: May 4, 2017
Article in press: May 5, 2017
Published online: September 14, 2017
Abstract
AIM

To investigate potential biomarkers for predicting postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD).

METHODS

We prospectively recruited 83 patients to this study. All patients underwent PD (Child’s procedure) at the Division of Hepatobiliary and Pancreas Surgery at the First Bethune Hospital of Jilin University between June 2011 and April 2015. Data pertaining to demographic variables, clinical characteristics, texture of pancreas, surgical approach, histopathological results, white blood cell count, amylase and choline levels in the serum, pancreatic/gastric drainage fluid, and choline and amylase levels in abdominal drainage fluid were included in the analysis. Potential correlations between these parameters and postoperative complications such as, POPF, acute pancreatitis, hemorrhage, delayed gastric emptying, and biliary fistula, were assessed.

RESULTS

Twenty-eight out of the 83 (33.7%) patients developed POPF. The severity of POPF was classified as Grade A in 8 (28%) patients, grade B in 16 (58%), and grade C in 4 (14%), according to the pancreatic fistula criteria. On univariate and multivariate logistic regression analyses, higher amylase level in the abdominal drainage fluid on postoperative day (POD)1 and higher serum amylase levels on POD4 showed a significant correlation with POPF (P < 0.05). On receiver operating characteristic curve analysis, amylase cut-off level of 2365.5 U/L in the abdominal drainage fluid was associated with a 78.6% sensitivity and 80% specificity [area under the curve (AUC): 0.844; P = 0.009]. A cut-off serum amylase level of 44.2 U/L was associated with a 78.6% sensitivity and 70.9% specificity (AUC: 0.784; P = 0.05).

CONCLUSION

Amylase level in the abdominal drainage fluid on POD1 and serum amylase level on POD4 represent novel biomarkers associated with POPF development.

Keywords: Pancreaticoduodenectomy, Complication, Amylase, Pancreatic fistula

Core tip: In this study, we sought to identify biomarkers that could help predict the risk of postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy. Diagnosis of POPF was based on the International Study Group of Pancreatic Fistula criteria. Association between POPF and various clinical and biochemical parameters was assessed. Amylase level in the abdominal drainage fluid on postoperative day 1 and serum amylase level on postoperative day 4 showed a significant association with POPF and represent novel biomarkers associated with POPF development.