Role of drain amylase levels assay and routinary postoperative day 3 abdominal CT scan in prevention of complications an
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ORIGINAL ARTICLE
Role of drain amylase levels assay and routinary postoperative day 3 abdominal CT scan in prevention of complications and management of surgical drains after pancreaticoduodenectomy Damiano Caputo1 · Silvia Angeletti2 · Massimo Ciccozzi3 · Mariacristina Cartillone1 · Chiara Cascone1 · Vincenzo La Vaccara1 · Alessandro Coppola1 · Roberto Coppola1 Received: 9 March 2020 / Accepted: 2 May 2020 / Published online: 14 May 2020 © Italian Society of Surgery (SIC) 2020
Abstract To asses drains amylase (DA) cut-offs for the risk of clinically relevant postoperative pancreatic fistula (POPF) and define the optimal timing of drains removal based on daily DA assay and abdominal CT scan finding after pancreatoduodenectomy (PD). Different algorithms able to identify patients at higher risk of POPF and to assess the optimal time for drains removal after PD have been proposed. The most accurate DA cut-offs in the assessment of the risk of clinically relevant POPF were retrospectively identified. Data from a prospective trial for optimal timing of drains removal were analyzed. Then, to validate the cut-offs identified in the first phase, they were applied to the patients enrolled in the prospective trial. Patients with POD1 DA ≥ 666 U/L were at higher risk of clinically relevant POPF (p 0.0001). POD3 DA value ≥ 252 U/L predicted 88% of clinical relevant fistulas. POD3 DA level ≥ 207 U/L was able to predict 68% of biliary fistulas. Patients with abdominal collection ≥ 5 cm, showed a significantly higher rate (60% vs. 23%, p
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