The correlation between postoperative pancreatic fistula and volume of amylase discharge in drainage fluid after pancreaticoduodenectomy

Daisuke Nobuoka, Naoto Gotohda, Masaru Konishi, Toshio Nakagohri, Shinichiro Takahashi, Taira Kinoshita

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Introduction:The operative morbidity and mortality associated with pancreaticoduodenectomy (PD) remains relatively high. Despite a recent study showing that removing prophylactic drains early reduced the incidence of infective post-PD complications, most surgeons hesitate to do so. We determined the correlation between postoperative pancreatic fistula(PF)and the volume of amylase discharge in post-PD drainage fluid. Patients and methods: Subjects were 73 consecutive cases of PD conducted between 2006 and 2008. PF was defined and scored based on criteria of the International Study Group on Pancreatic Fistulas, i.e., any appreciable drainage from a drain placed during surgery with an amylase activity greater than three times the upper limit of normal serum amylase activity measured on or after postoperative day (POD) 3 (grade A, called " transient fistula," it has no clinical impact)grade B, required a change in management or adjustment in the clinical pathway)grade C, a major change in clinical management or deviation from the normal clinical pathway: And in this study, we defined PF as grade B/ C. Drain data, including amylase levels of drainage fluid (D-Amy) and the product of D-Amy and drainage volume, was compared between a group with PF(PF(+)) and one without PF(PF-)) Results:The incidence of PF in all patients was 27%. The incidence of PF was 49% in subjects with a soft pancreas and 6% in those with a hard pancreas. Risk factors for PF were obesity and soft pancreatic texture. D-Amy was significantly higher in the PF(+) group than in the PF(-) group on POD 1, 3, 5, and 7. The product of D-Amy and drainage volume was significantly higher in the PF(+) group than in the PF(-)group on POD 1 and 7, but no statistically significant difference was seen in that on POD 3and5. Conclusion:The product of D-Amy and drainage volume equals the volume of amylase discharge in drains. PF appears to develop on POD 7 in many cases, so care must be taken in the early removal of prophy-lactic drains in patients with a soft pancreas.

Original languageEnglish
Pages (from-to)351-358
Number of pages8
JournalJapanese Journal of Gastroenterological Surgery
Volume43
Issue number4
Publication statusPublished - Apr 2010
Externally publishedYes

Fingerprint

Pancreatic Fistula
Pancreaticoduodenectomy
Amylases
Drainage
Pancreas
Critical Pathways
Incidence

Keywords

  • Amylase
  • Drainage
  • Pancreatic fistula
  • Pancreaticoduodenectomy
  • Postoperative complication

ASJC Scopus subject areas

  • Gastroenterology
  • Surgery

Cite this

The correlation between postoperative pancreatic fistula and volume of amylase discharge in drainage fluid after pancreaticoduodenectomy. / Nobuoka, Daisuke; Gotohda, Naoto; Konishi, Masaru; Nakagohri, Toshio; Takahashi, Shinichiro; Kinoshita, Taira.

In: Japanese Journal of Gastroenterological Surgery, Vol. 43, No. 4, 04.2010, p. 351-358.

Research output: Contribution to journalArticle

Nobuoka, Daisuke ; Gotohda, Naoto ; Konishi, Masaru ; Nakagohri, Toshio ; Takahashi, Shinichiro ; Kinoshita, Taira. / The correlation between postoperative pancreatic fistula and volume of amylase discharge in drainage fluid after pancreaticoduodenectomy. In: Japanese Journal of Gastroenterological Surgery. 2010 ; Vol. 43, No. 4. pp. 351-358.
@article{440989bd31944dd08fb55265678574b0,
title = "The correlation between postoperative pancreatic fistula and volume of amylase discharge in drainage fluid after pancreaticoduodenectomy",
abstract = "Introduction:The operative morbidity and mortality associated with pancreaticoduodenectomy (PD) remains relatively high. Despite a recent study showing that removing prophylactic drains early reduced the incidence of infective post-PD complications, most surgeons hesitate to do so. We determined the correlation between postoperative pancreatic fistula(PF)and the volume of amylase discharge in post-PD drainage fluid. Patients and methods: Subjects were 73 consecutive cases of PD conducted between 2006 and 2008. PF was defined and scored based on criteria of the International Study Group on Pancreatic Fistulas, i.e., any appreciable drainage from a drain placed during surgery with an amylase activity greater than three times the upper limit of normal serum amylase activity measured on or after postoperative day (POD) 3 (grade A, called {"} transient fistula,{"} it has no clinical impact)grade B, required a change in management or adjustment in the clinical pathway)grade C, a major change in clinical management or deviation from the normal clinical pathway: And in this study, we defined PF as grade B/ C. Drain data, including amylase levels of drainage fluid (D-Amy) and the product of D-Amy and drainage volume, was compared between a group with PF(PF(+)) and one without PF(PF-)) Results:The incidence of PF in all patients was 27{\%}. The incidence of PF was 49{\%} in subjects with a soft pancreas and 6{\%} in those with a hard pancreas. Risk factors for PF were obesity and soft pancreatic texture. D-Amy was significantly higher in the PF(+) group than in the PF(-) group on POD 1, 3, 5, and 7. The product of D-Amy and drainage volume was significantly higher in the PF(+) group than in the PF(-)group on POD 1 and 7, but no statistically significant difference was seen in that on POD 3and5. Conclusion:The product of D-Amy and drainage volume equals the volume of amylase discharge in drains. PF appears to develop on POD 7 in many cases, so care must be taken in the early removal of prophy-lactic drains in patients with a soft pancreas.",
keywords = "Amylase, Drainage, Pancreatic fistula, Pancreaticoduodenectomy, Postoperative complication",
author = "Daisuke Nobuoka and Naoto Gotohda and Masaru Konishi and Toshio Nakagohri and Shinichiro Takahashi and Taira Kinoshita",
year = "2010",
month = "4",
language = "English",
volume = "43",
pages = "351--358",
journal = "Japanese Journal of Gastroenterological Surgery",
issn = "0386-9768",
publisher = "Japanese Society of Gastroenterological Surgery",
number = "4",

}

TY - JOUR

T1 - The correlation between postoperative pancreatic fistula and volume of amylase discharge in drainage fluid after pancreaticoduodenectomy

AU - Nobuoka, Daisuke

AU - Gotohda, Naoto

AU - Konishi, Masaru

AU - Nakagohri, Toshio

AU - Takahashi, Shinichiro

AU - Kinoshita, Taira

PY - 2010/4

Y1 - 2010/4

N2 - Introduction:The operative morbidity and mortality associated with pancreaticoduodenectomy (PD) remains relatively high. Despite a recent study showing that removing prophylactic drains early reduced the incidence of infective post-PD complications, most surgeons hesitate to do so. We determined the correlation between postoperative pancreatic fistula(PF)and the volume of amylase discharge in post-PD drainage fluid. Patients and methods: Subjects were 73 consecutive cases of PD conducted between 2006 and 2008. PF was defined and scored based on criteria of the International Study Group on Pancreatic Fistulas, i.e., any appreciable drainage from a drain placed during surgery with an amylase activity greater than three times the upper limit of normal serum amylase activity measured on or after postoperative day (POD) 3 (grade A, called " transient fistula," it has no clinical impact)grade B, required a change in management or adjustment in the clinical pathway)grade C, a major change in clinical management or deviation from the normal clinical pathway: And in this study, we defined PF as grade B/ C. Drain data, including amylase levels of drainage fluid (D-Amy) and the product of D-Amy and drainage volume, was compared between a group with PF(PF(+)) and one without PF(PF-)) Results:The incidence of PF in all patients was 27%. The incidence of PF was 49% in subjects with a soft pancreas and 6% in those with a hard pancreas. Risk factors for PF were obesity and soft pancreatic texture. D-Amy was significantly higher in the PF(+) group than in the PF(-) group on POD 1, 3, 5, and 7. The product of D-Amy and drainage volume was significantly higher in the PF(+) group than in the PF(-)group on POD 1 and 7, but no statistically significant difference was seen in that on POD 3and5. Conclusion:The product of D-Amy and drainage volume equals the volume of amylase discharge in drains. PF appears to develop on POD 7 in many cases, so care must be taken in the early removal of prophy-lactic drains in patients with a soft pancreas.

AB - Introduction:The operative morbidity and mortality associated with pancreaticoduodenectomy (PD) remains relatively high. Despite a recent study showing that removing prophylactic drains early reduced the incidence of infective post-PD complications, most surgeons hesitate to do so. We determined the correlation between postoperative pancreatic fistula(PF)and the volume of amylase discharge in post-PD drainage fluid. Patients and methods: Subjects were 73 consecutive cases of PD conducted between 2006 and 2008. PF was defined and scored based on criteria of the International Study Group on Pancreatic Fistulas, i.e., any appreciable drainage from a drain placed during surgery with an amylase activity greater than three times the upper limit of normal serum amylase activity measured on or after postoperative day (POD) 3 (grade A, called " transient fistula," it has no clinical impact)grade B, required a change in management or adjustment in the clinical pathway)grade C, a major change in clinical management or deviation from the normal clinical pathway: And in this study, we defined PF as grade B/ C. Drain data, including amylase levels of drainage fluid (D-Amy) and the product of D-Amy and drainage volume, was compared between a group with PF(PF(+)) and one without PF(PF-)) Results:The incidence of PF in all patients was 27%. The incidence of PF was 49% in subjects with a soft pancreas and 6% in those with a hard pancreas. Risk factors for PF were obesity and soft pancreatic texture. D-Amy was significantly higher in the PF(+) group than in the PF(-) group on POD 1, 3, 5, and 7. The product of D-Amy and drainage volume was significantly higher in the PF(+) group than in the PF(-)group on POD 1 and 7, but no statistically significant difference was seen in that on POD 3and5. Conclusion:The product of D-Amy and drainage volume equals the volume of amylase discharge in drains. PF appears to develop on POD 7 in many cases, so care must be taken in the early removal of prophy-lactic drains in patients with a soft pancreas.

KW - Amylase

KW - Drainage

KW - Pancreatic fistula

KW - Pancreaticoduodenectomy

KW - Postoperative complication

UR - http://www.scopus.com/inward/record.url?scp=77953065409&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77953065409&partnerID=8YFLogxK

M3 - Article

AN - SCOPUS:77953065409

VL - 43

SP - 351

EP - 358

JO - Japanese Journal of Gastroenterological Surgery

JF - Japanese Journal of Gastroenterological Surgery

SN - 0386-9768

IS - 4

ER -