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Identification of an Optimal Cut-off for Drain Fluid Amylase on Postoperative Day 1 for Predicting Clinically Relevant Fistula After Distal Pancreatectomy: A Multi-institutional Analysis and External Validation.
Maggino, Laura; Malleo, Giuseppe; Bassi, Claudio; Allegrini, Valentina; Beane, Joal D; Beckman, Ross M; Chen, Bofeng; Dickson, Euan J; Drebin, Jeffrey A; Ecker, Brett L; Fraker, Douglas L; House, Michael G; Jamieson, Nigel B; Javed, Ammar A; Kowalsky, Stacy J; Lee, Major K; McMillan, Matthew T; Roses, Robert E; Salvia, Roberto; Valero, Vicente; Velu, Lavanniya K P; Wolfgang, Christopher L; Zureikat, Amer H; Vollmer, Charles M.
Afiliación
  • Maggino L; Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
  • Malleo G; Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
  • Bassi C; Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
  • Allegrini V; Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
  • Beane JD; Department of Surgery, University of Verona, The Pancreas Institute, Verona, Italy.
  • Beckman RM; Department of Surgery, Indiana University School of Medicine, Indianapolis, IN.
  • Chen B; Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
  • Dickson EJ; Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD.
  • Drebin JA; Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
  • Ecker BL; Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA Memorial Sloan Kettering Cancer Center, New York, NY.
  • Fraker DL; Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
  • House MG; Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
  • Jamieson NB; Department of Surgery, University of Verona, The Pancreas Institute, Verona, Italy.
  • Javed AA; Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD.
  • Kowalsky SJ; Department of Surgery, Indiana University School of Medicine, Indianapolis, IN.
  • Lee MK; Department of Surgery, West of Scotland Pancreatic Unit, Glasgow Royal Infirmary, Glasgow, UK.
  • McMillan MT; Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
  • Roses RE; Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
  • Salvia R; Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
  • Valero V; Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
  • Velu LKP; Department of Surgery, Indiana University School of Medicine, Indianapolis, IN.
  • Wolfgang CL; Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD.
  • Zureikat AH; Department of Surgery, Indiana University School of Medicine, Indianapolis, IN.
  • Vollmer CM; Department of Surgery, West of Scotland Pancreatic Unit, Glasgow Royal Infirmary, Glasgow, UK.
Ann Surg ; 269(2): 337-343, 2019 02.
Article en En | MEDLINE | ID: mdl-28938266
OBJECTIVE: The aim of this study was to investigate the relationship between drain fluid amylase value on the first postoperative day (DFA1) and clinically relevant fistula (CR-POPF) after distal pancreatectomy (DP), and to identify the cut-off of DFA1 that optimizes CR-POPF prediction. BACKGROUND: DFA1 is a well-recognized predictor of CR-POPF after pancreatoduodenectomy, but its role in DP is largely unexplored. METHODS: DFA1 levels were correlated with CR-POPF in 2 independent multi-institutional sets of DP patients: developmental (n = 338; years 2012 to 2017) and validation cohort (n = 166; years 2006 to 2016). Cut-off choice was based on Youden index calculation, and its ability to predict CR-POPF occurrence was tested in a multivariable regression model adjusted for clinical, demographic, operative, and pathological variables. RESULTS: In the developmental set, median DFA1 was 1745 U/L and the CR-POPF rate was 21.9%. DFA1 correlated with CR-POPF with an area under the curve of 0.737 (P < 0.001). A DFA1 of 2000 U/L had the highest Youden index, with 74.3% sensitivity and 62.1% specificity. Patients in the validation cohort displayed different demographic and operative characteristics, lower values of DFA1 (784.5 U/L, P < 0.001), and reduced CR-POPF rate (10.2%, P < 0.001). However, a DFA1 of 2000 U/L had the highest Youden index in this cohort as well, with 64.7% sensitivity and 75.8% specificity. At multivariable analysis, DFA1 ≥2000 U/L was the only factor significantly associated with CR-POPF in both cohorts. CONCLUSION: A DFA1 of 2000 U/L optimizes CR-POPF prediction after DP. These results provide the substrate to define best practices and improve outcomes for patients receiving DP.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Pancreatectomía / Cuidados Posoperatorios / Líquidos Corporales / Amilasas Tipo de estudio: Diagnostic_studies / Guideline / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Ann Surg Año: 2019 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
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XML
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Pancreatectomía / Cuidados Posoperatorios / Líquidos Corporales / Amilasas Tipo de estudio: Diagnostic_studies / Guideline / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Ann Surg Año: 2019 Tipo del documento: Article Pais de publicación: Estados Unidos