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Postoperative drain amylase predicts pancreatic fistula in pancreatic surgery: A systematic review and meta-analysis

Published on Oct 1, 2015in International Journal of Surgery
· DOI :10.1016/j.ijsu.2015.07.007
Ji Yang2
Estimated H-index: 2
(Anhui Medical University),
Qiang Huang2
Estimated H-index: 2
(Anhui Medical University),
Chao Wang2
Estimated H-index: 2
(Anhui Medical University)
Abstract
Abstract Background and objectives This study to evaluate the utility of drain fluid amylase as a predictor of PF in patients undergoing pancreatic surgery based on the International Study Group of Pancreatic Fistula definitions of pancreatic fistula. Methods A comprehensive search was carried out using Pubmed (Medline), Embase, Web of science and Cochrane database for clinical trials, which studied DFA as a diagnostic marker for pancreatic fistula after pancreatic surgery. Sensitivity, specificity and the diagnostic odds ratios with 95% confidence interval were calculated for each study. Summary receiver-operating curves were conducted and the area under the curve was evaluated. Results A total of 10 studies were included. The pooled sensitivity and specificity of drain fluid amylase Day 1 for the diagnosis of postoperative pancreatic fistula were 81% and 87%, respectively (area under the curve was 0.897, diagnostic odds ratios was 16.83 and 95%CI was 12.66–22.36), the pooled sensitivity and specificity of drain fluid amylase Day 3 for the diagnosis of postoperative pancreatic fistula were 56% and 79%, respectively (area under the curve was 0.668, diagnostic odds ratios was 3.26 and 95%CI was 1.83–5.82) Conclusions The drain fluid amylase Day 1, instead of drain fluid amylase Day 3, may be a useful criterion for the early identification of postoperative pancreatic fistula, and a value of drain fluid amylase Day 1 over than 1300 U/L was a risk factor of pancreatic fistula. And the diagnostic accuracy and the proposed cut-off levels of drain fluid amylase Day 1 in predicting the postoperative pancreatic fistula will have to be validated by multicenter prospective studies.
  • References (52)
  • Citations (9)
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References52
Newest
#1Stefano PartelliH-Index: 29
#2Domenico TamburrinoH-Index: 13
Last. Massimo FalconiH-Index: 79
view all 6 authors...
Abstract Background Amylase value in drains (AVD) is a predictor of pancreatic fistula (PF). We evaluated the accuracy of an AVD-based model. Methods Two hundred thirty-one patients underwent pancreatoduodenectomy with pancreaticojejunostomy (PDPJ) or pancreatoduodenectomy with duct-to-mucosa (PDDTM) and distal pancreatectomy (DP). Patients with AVD greater than 5,000 U/L on postoperative day (POD) 1 underwent AVD measurement on POD5. Results Sensitivity and specificity of POD1 AVD greater than ...
18 CitationsSource
#1Mitsuro KandaH-Index: 30
#2Tsutomu FujiiH-Index: 35
Last. Yasuhiro KoderaH-Index: 54
view all 13 authors...
AIM: To identify sensitive predictors of clinically relevant postoperative pancreatic fistula (POPF) at the acute phase after pancreatectomy. METHODS: This study included 153 patients diagnosed as having POPFs at postoperative day (POD) 3 after either open pancreatoduodenectomy or distal pancreatectomy between January 2008 and March 2013. The POPFs were categorized into three grades based on the International Study Group on Pancreatic Fistula Definition, and POPFs of grades B or C were considere...
16 CitationsSource
#1Jacqueline S. Israel (UW: University of Wisconsin-Madison)H-Index: 6
#2Robert J. Rettammel (UW: University of Wisconsin-Madison)H-Index: 9
Last. Sharon M. Weber (UW: University of Wisconsin-Madison)H-Index: 37
view all 7 authors...
Background Previous studies suggest that after pancreatectomy, drain fluid amylase obtained on postoperative day 1 (DFA1) >5,000 U/L correlates with the development of postoperative pancreatic fistula (PF). 1,2 We sought to validate whether DFA1 is a clinically useful predictor of PF and to evaluate whether DFA1 correlates with PF severity. Study Design Using a prospective database, we reviewed records from patients having pancreatectomy between 2010 and 2012. Presence and grade of PF were deter...
26 CitationsSource
#1Christoph Ansorge (Karolinska University Hospital)H-Index: 10
#2Joel Z. Nordin (Karolinska University Hospital)H-Index: 12
Last. Ralf Segeravärd (Karolinska University Hospital)H-Index: 22
view all 8 authors...
Background The use of prophylactic abdominal drainage following pancreaticoduodenectomy (PD) is controversial as its therapeutic value is uncertain. However, the diagnosis of postoperative pancreatic fistula (POPF), the main cause of PD-associated morbidity, is often based on drain pancreatic amylase (DPA) levels. The aim of this study was to assess the predictive value of DPA, plasma pancreatic amylase (PPA) and serum C-reactive protein (CRP) for diagnosing POPF after PD. Methods Patients under...
28 CitationsSource
#1Wei-Chih Liao (NTU: National Taiwan University)H-Index: 20
#2Kuo-Liong Chien (NTU: National Taiwan University)H-Index: 41
Last. Yu-Kang Tu (NTU: National Taiwan University)H-Index: 34
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Summary Background Major adjuvant treatments for pancreatic adenocarcinoma include fluorouracil, gemcitabine, chemoradiation, and chemoradiation plus fluorouracil or gemcitabine. Since the optimum regimen remains inconclusive, we aimed to compare these treatments in terms of overall survival after tumour resection and in terms of grade 3–4 toxic effects with a systematic review and random-effects Bayesian network meta-analysis. Methods We searched PubMed, trial registries, and related reviews an...
112 CitationsSource
#1Masahide Hiyoshi (University of Miyazaki)H-Index: 10
#2Kazuo Chijiiwa (University of Miyazaki)H-Index: 44
Last. Jiro Ohuchida (University of Miyazaki)H-Index: 20
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Background Postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD) is a worrisome and life-threatening complication. Recently, early drain removal has been recommended as a means of preventing POPF. The present study sought to determine how to distinguish clinical POPF from non-clinical POPF in the early postoperative period after PD to aid in early drain removal.
27 CitationsSource
#1Ayman El Nakeeb (Mansoura University)H-Index: 18
#2Tarek Salah (Mansoura University)H-Index: 11
Last. Talaat Abdallah (Mansoura University)H-Index: 4
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Background Postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD) remains a challenge even at high-volume centers.
90 CitationsSource
#1Mark P. Callery (BIDMC: Beth Israel Deaconess Medical Center)H-Index: 48
#2Wande B. Pratt (WashU: Washington University in St. Louis)H-Index: 17
Last. Charles M. Vollmer (UPenn: University of Pennsylvania)H-Index: 40
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Background Clinically relevant postoperative pancreatic fistulas (CR-POPF) are serious inherent risks of pancreatic resection. Preoperative CR-POPF risk assessment is currently inadequate and rarely disqualifies patients who need resection. The best evaluation of risk occurs intraoperatively, and should guide fistula prevention and response measures thereafter. We sought to develop a risk prediction tool for CR-POPF that features intraoperative assessment and reveals associated clinical and econ...
301 CitationsSource
#1Nicholas N. NissenH-Index: 19
#2Vijay G. MenonH-Index: 6
Last. Brendan BolandH-Index: 5
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#1Takehiro NojiH-Index: 10
#2Toru NakamuraH-Index: 13
Last. Nobuichi KashimuraH-Index: 10
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Cited By9
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#1Jun Yoshino (Tokyo Medical and Dental University)
#2Daisuke Ban (Tokyo Medical and Dental University)H-Index: 16
Last. Minoru Tanabe (Tokyo Medical and Dental University)H-Index: 26
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Objectives Pancreatic fistula after distal pancreatectomy (DP) remains an unsolved problem, and postoperative CT imaging often demonstrates fluid collection (FC) around the pancreatic remnant. This study sought to clarify the clinical implications of FC.
Source
#1Mario Gruppo (UNIPD: University of Padua)H-Index: 13
#2Imerio Angriman (UNIPD: University of Padua)H-Index: 22
Last. Romeo Bardini (UNIPD: University of Padua)H-Index: 19
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#1Enio Campos Amico (UFRN: Federal University of Rio Grande do Norte)H-Index: 3
#2Ítalo Medeiros Azevedo (UFRN: Federal University of Rio Grande do Norte)H-Index: 9
Last. Samir Assi João (UFRN: Federal University of Rio Grande do Norte)H-Index: 3
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#1Théophile Guilbaud (AMU: Aix-Marseille University)H-Index: 3
#2David Jérémie Birnbaum (AMU: Aix-Marseille University)H-Index: 5
Last. Vincent Moutardier (AMU: Aix-Marseille University)H-Index: 30
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Background Postoperative pancreatic fistula and pancreas-specific complications have a significant influence on patient management and outcomes after pancreatoduodenectomy. The aim of the study was to assess the value of serum C-reactive protein on the postoperative day 1 as early predictor of pancreatic fistula and pancreas-specific complications.
1 CitationsSource
AbstractBackground:Pancreatoduodenectomy (PD) is one of the most technically demanding operations challenging surgeons, and a postoperative pancreatic fistula (POPF) can complicate an otherwise uneventful postoperative (PO) course. This review examined the methods and procedures used to prevent post
15 CitationsSource
#1Tsetsegdemberel Bat‐Ulzii Davidson (UCL: University College London)
#2Mohammad Yaghoobi (McMaster University)H-Index: 18
Last. Kurinchi Selvan Gurusamy (UCL: University College London)H-Index: 45
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Background The treatment of people with clinically significant postoperative pancreatic leaks is different from those without clinically significant pancreatic leaks. It is important to know the diagnostic accuracy of drain fluid amylase as a triage test for the detection of clinically significant pancreatic leaks, so that an informed decision can be made as to whether the patient with a suspected pancreatic leak needs further investigations and treatment. There is currently no systematic review...
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#1Wenlong ZhangH-Index: 3
#2Huimin TaoH-Index: 1
Last. Lizhi NiuH-Index: 7
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Background The most common major complication after pancreatic resection is the postoperative pancreatic fistula (POPF). Somatostatin analogs can reduce POPF, but the use of somatostatin analogs is still controversial. The aim of this study was to assess treatment algorithms for pancreatic surgery in Germany with a special focus on the application of somatostatin analogs.
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#1Yang Gao (SJTU: Shanghai Jiao Tong University)H-Index: 6
#2Yayun Zhu (SJTU: Shanghai Jiao Tong University)H-Index: 3
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Background The aim of this study was to evaluate the clinical efficiency of transduodenal ampullectomy (TDA) compared to conventional pancreatoduodenectomy (PD) in patients with early ampullary cancers.
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