Analysis Of Risk Factors For Postoperative Pancreatic Fistula And Predictive Value Of Amylase Level In Drains After Pancreatic Resection

Background:The morbidity of pancreatic resection remains high now and postoperative pancreatic fistula(PF)continues to be the most frequent complication after the procedure.Amylase value in drain(AVD)is known as the diagnostic factor of PF according to the PF definition and grading of the International Study Group on Pancreatic Surgery(ISGPS).But the correlation of AVD with the development of PF is still unclear.And the predictive factor of PF is also uncertain.Objective The purpose of this study was to identify within the first postoperative day(POD1)the predictive role of different risk factors,including AVD,in the development of PF.And providing an useful method for selecting the low risk group of patients of pancreatic fistula development.Method:We prospectively investigated patients who underwent major pancreatic resections from June 1,2017 to March 31,2018.PF was defined and graded in accordance with the ISGPS.The relevant factors were analyzed by univariate and multivariate analyses.Result:A total of 88 patients were included in this study,including 77 patients underwent pancreatoduodenectomy(PD)and 11 patients underwent distal pancreatectomy(DP).The overall incidence of PF(B,and C grades)was 37.3% and it was 35% after pancreaticoduodenectomy and 36.4% after distal pancreatectomy.In the univariate analysis,the pancreatic texture,the diameter of the main pancreatic duct,and the amylase value of drain in POD1 were statistically significant(P=0.006,P< 0.001,P < 0.001).In multivariate analysis,the pancreatic duct diameter and amylase value of drain in POD1 were still statistically significant(P=0.022,OR=0.229,P=0.001,OR=1.000).The area under the receiver operating characteristic(ROC)curve was 0.865(P<0.001),and the best threshold was 1300U/L.We established a cut-off of 1300U/L POD1 AVD for univariate and multivariate analysis,and it was stillstatistically significant(P=0.004,OR=10.287,95% CI:2.147-49.298,positive predictive value =67.5%,negative predictive value =91.7%).Conclusion:The diameter of the main pancreatic duct and the amylase value in the abdominal drainage in the first day after operation can be used as an effective predictive factor for the postoperative pancreatic fistula.The risk of pancreatic fistula is higher when the diameter of the main pancreatic duct > 3mm and/or the amylase value in drain in the first postoperative day > 1300U/L.