R J A Linnemann1, G A Patijn1, L B van Rijssen2, M G Besselink2, T H Mungroop2, I H de Hingh3, G Kazemier4, S Festen5, K P de Jong6, C H J van Eijck7, J J G Scheepers8, M van der Kolk9, M den Dulk10, K Bosscha11, O R Busch2, D Boerma12, E van der Harst13, V B Nieuwenhuijs14. 1. Isala, Department of Surgery, Zwolle, the Netherlands. 2. Academic Medical Center, Department of Surgery, Cancer Center Amsterdam, Amsterdam, the Netherlands. 3. Catharina Hospital, Department of Surgery, Eindhoven, the Netherlands. 4. VU Medical Center, Department of Surgery, Amsterdam, the Netherlands. 5. OLVG Oost, Department of Surgery, Amsterdam, the Netherlands. 6. University of Groningen, University Medical Center Groningen, Department of HPB Surgery and Liver Transplantation, Groningen, the Netherlands. 7. Erasmus Medical Center, Department of Surgery, Rotterdam, the Netherlands. 8. Reinier de Graaf Hospital, Department of Surgery, Delft, the Netherlands. 9. Radboud University Medical Center, Department of Surgery, Nijmegen, the Netherlands. 10. Maastricht University Medical Center, Department of Surgery, Maastricht, the Netherlands. 11. Jeroen Bosch Hospital, Department of Surgery, 's-Hertogenbosch, the Netherlands. 12. St. Antonius Hospital, Department of Surgery, Nieuwegein, the Netherlands. 13. Maasstad Hospital, Department of Surgery, Rotterdam, the Netherlands. 14. Isala, Department of Surgery, Zwolle, the Netherlands. Electronic address: v.b.nieuwenhuijs@isala.nl.
Abstract
BACKGROUND: Abdominal drainage and the timing of drain removal in patients undergoing pancreatic resection are under debate. Early drain removal after pancreatic resection has been reported to be safe with a low risk for clinical relevant postoperative pancreatic fistula (CR-POPF) when drain amylase on POD1 is < 5000U/L. The aim of this study was to validate this algorithm in a large national cohort. METHODS: Patients registered in the Dutch Pancreatic Cancer Audit (2014-2016) who underwent pancreatoduodenectomy, distal pancreatectomy or enucleation were analysed. Data on post-operative drain amylase levels, drain removal, postoperative pancreatic fistulae were collected. Univariate and multivariate analysis using a logistic regression model were performed. The primary outcome measure was grade B/C pancreatic fistula (CR-POPF). RESULTS: Among 1402 included patients, 433 patients with a drain fluid amylase level of <5000U/L on POD1, 7% developed a CR-POPF. For patients with an amylase level >5000U/L the CR-POPF rate was 28%. When using a cut-off point of 2000U/L or 1000U/L during POD1-3, the CR-POPF rates were 6% and 5% respectively. For patients with an amylase level of >2000U/L and >1000UL during POD 1-3 the CR-POPF rates were 26% and 22% respectively (n = 223). Drain removal on POD4 or thereafter was associated with more complications (p = 0.004). Drain amylase level was shown to be the most statistically significant predicting factor for CR-POPF (Wald = 49.7; p < 0.001). CONCLUSION: Our data support early drain removal after pancreatic resection. However, a cut-off of 5000U/L drain amylase on POD1 was associated with a relatively high CR-POPF rate of 7%. A cut-off point of 1000U/L during POD1-3 resulted in 5% CR-POPF and might be a safer alternative.
BACKGROUND: Abdominal drainage and the timing of drain removal in patients undergoing pancreatic resection are under debate. Early drain removal after pancreatic resection has been reported to be safe with a low risk for clinical relevant postoperative pancreatic fistula (CR-POPF) when drain amylase on POD1 is < 5000U/L. The aim of this study was to validate this algorithm in a large national cohort. METHODS:Patients registered in the Dutch Pancreatic Cancer Audit (2014-2016) who underwent pancreatoduodenectomy, distal pancreatectomy or enucleation were analysed. Data on post-operative drain amylase levels, drain removal, postoperative pancreatic fistulae were collected. Univariate and multivariate analysis using a logistic regression model were performed. The primary outcome measure was grade B/C pancreatic fistula (CR-POPF). RESULTS: Among 1402 included patients, 433 patients with a drain fluid amylase level of <5000U/L on POD1, 7% developed a CR-POPF. For patients with an amylase level >5000U/L the CR-POPF rate was 28%. When using a cut-off point of 2000U/L or 1000U/L during POD1-3, the CR-POPF rates were 6% and 5% respectively. For patients with an amylase level of >2000U/L and >1000UL during POD 1-3 the CR-POPF rates were 26% and 22% respectively (n = 223). Drain removal on POD4 or thereafter was associated with more complications (p = 0.004). Drain amylase level was shown to be the most statistically significant predicting factor for CR-POPF (Wald = 49.7; p < 0.001). CONCLUSION: Our data support early drain removal after pancreatic resection. However, a cut-off of 5000U/L drain amylase on POD1 was associated with a relatively high CR-POPF rate of 7%. A cut-off point of 1000U/L during POD1-3 resulted in 5% CR-POPF and might be a safer alternative.