Usefulness of Drain Lipase to Predict Postoperative Pancreatic Fistula After Distal Pancreatectomy
- PDF / 595,209 Bytes
- 7 Pages / 595.276 x 790.866 pts Page_size
- 23 Downloads / 194 Views
ORIGINAL ARTICLE
Usefulness of Drain Lipase to Predict Postoperative Pancreatic Fistula After Distal Pancreatectomy Masahide Hiyoshi 1 & Takashi Wada 1 & Yuki Tsuchimochi 1 & Takeomi Hamada 1 & Koichi Yano 1 & Naoya Imamura 1 & Yoshiro Fujii 1 & Atsushi Nanashima 1 Received: 18 April 2019 / Accepted: 11 March 2020 # Association of Surgeons of India 2020
Abstract Postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP) is a worrisome and life-threatening complication. The aim of this study was to clarify the risk factors and to find the early detective method of POPF after DP. From January 2010 through December 2014, 37 patients underwent DP and were enrolled in this study to examine the factors predictive of clinical POPF after DP. POPF was defined and classified according to the International Study Group of Pancreatic Surgery guideline 2016. Biochemical leakage occurred in 14 (37.8%) patients, grade B POPF in 16 (43.2%) patients, and no grade C POPF in any patient. Clinical POPF (grade B/C) occurred in 43.2% of patients. Multivariate analysis revealed pancreatic thickness ≥ 14 mm to be the independent preoperative risk factors predictive of POPF. Receiver operating characteristic curves showed that the drain lipase ≥ 800 IU/L on postoperative day 4 could distinguish clinical POPF from non-clinical POPF effectively. Sensitivity, specificity, and accuracy were 93.8%, 70.0%, and 80.6% respectively. Pancreatic thickness ≥ 14 mm was the independent preoperative predictive risk factors for POPF. A drain lipase level of ≥800 IU/L on POD 4 was useful to find clinical POPF after DP. Keywords Distal pancreatectomy . POPF . Drain lipase . Drain amylase
Introduction Postoperative pancreatic fistula (POPF) after pancreatic surgery is a specific, most worrisome, and life-threatening complication, with reported incidences of 10–40% [1–3] in pancreaticoduodenectomy (PD) and 20–60% in distal pancreatectomy (DP) [4–6] that have been difficult to reduce. Many articles have reported the risk factors for POPF as male gender [2, 7], intraoperative massive bleeding [2], soft pancreas [2], hypoalbuminemia [1], high BMI [7], and predictive factors of POPF as drain amylase on postoperative day (POD) 1 of > 4000 IU/L in PD [2], leukocyte count of > 9800 mm−3 on POD 4 [1]. We already reported on preoperative risk factors as male gender, BMI of ≥ 22.5 kg/m2, and a method of early detection of POPF in PD as the combination of drain amylase of ≥ 750 IU/L, serum C-reactive protein (CRP) of ≥ 20 mg/dL, * Masahide Hiyoshi [email protected] 1
Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan
and body temperature ≥ 37.5 °C on POD 3 [7]. Almost all the surgeons know that early drain removal is recommended to prevent POPF, in the view points of fast-track recovery and enhanced recovery after surgery. However, many surgeons suffer from when to remove the drain, especially the drain amylase which indicates hig
Data Loading...
