Review
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Oct 27, 2022; 14(10): 1089-1106
Published online Oct 27, 2022. doi: 10.4240/wjgs.v14.i10.1089
Drain fluid biomarkers for prediction and diagnosis of clinically relevant postoperative pancreatic fistula: A narrative review
Nadya Rykina-Tameeva, Jaswinder S Samra, Sumit Sahni, Anubhav Mittal
Nadya Rykina-Tameeva, Jaswinder S Samra, Sumit Sahni, Anubhav Mittal, Northern Clinical School, University of Sydney, St Leonards 2065, Australia
Author contributions: Rykina-Tameeva N wrote the paper; Samra JS, Sahni S and Mittal A provided feedback and revised the paper; Sahni S and Mittal A have contributed equally as senior authors.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sumit Sahni, PhD, Research Fellow, Senior Research Fellow, Northern Clinical School, University of Sydney, Level 8, Kolling Building, Royal North Shore Hospital Campus, St Leonards 2065, Australia. sumit.sahni@sydney.edu.au
Received: June 16, 2022
Peer-review started: June 16, 2022
First decision: September 4, 2022
Revised: September 16, 2022
Accepted: October 14, 2022
Article in press: October 14, 2022
Published online: October 27, 2022
Abstract

Clinically relevant postoperative pancreatic fistula (CR-POPF) has continued to compromise patient recovery post-pancreatectomy despite decades of research seeking to improve risk prediction and diagnosis. The current diagnostic criteria for CR-POPF requires elevated drain fluid amylase to present alongside POPF-related complications including infection, haemorrhage and organ failure. These worrying sequelae necessitate earlier and easily obtainable biomarkers capable of reflecting evolving CR-POPF. Drain fluid has recently emerged as a promising source of biomarkers as it is derived from the pancreas and hence, capable of reflecting its postoperative condition. The present review aims to summarise the current knowledge of CR-POPF drain fluid biomarkers and identify gaps in the field to invigorate future research in this critical area of clinical need. These findings may provide robust diagnostic alternatives for CR-POPF and hence, to clarify their clinical utility require further reports detailing their diagnostic and/or predictive accuracy.

Keywords: Biomarkers, Clinically relevant postoperative pancreatic fistula, Diagnosis, Drain fluid, Prediction

Core Tip: This review demonstrates the potential for drain fluid biomarkers to overcome the limitations of the current diagnostic definition of clinically relevant postoperative pancreatic fistula. Numerous future directions for drain fluid research have been identified, where ideally, new biomarkers would report the accuracy of surgery-specific, risk-stratified cut-offs to clarify their clinical utility. Hence, decisions regarding drain removal and further monitoring can accordingly be made to either expediate or make recovery safer respectively. These improvements will invariably bolster pancreatic ductal adenocarcinoma survival outcomes by tapering the high morbidity of pancreatectomies and ensuring better quality of life for patients.