The Prognostic Value of Drain Amylase on Post-Operative Day One after the Whipple Procedure

Introduction For patients with periampullary tumors, the only treatment with curative intention is resection. One potentially serious complication is a postoperative pancreatic fistula. The reported risk factors are a soft pancreas and a small pancreatic duct as well as overweight/ obesity. The aim of this study was to investigate the prognostic value for a postoperative pancreatic fistula of elevated drain amylase (>3 times the upper limit in serum) on postoperative day 1. Results In total, 170 patients underwent a pancreaticoduodenectomy at Linköping University Hospital between 2011 and 2014; 27 patients (16%) had a postoperative complication ≥ grade 3b, and the postoperative mortality was 3%. The patients with elevated drain amylase on postoperative day one (n=65) had more complications (≥3b) than the patients without elevated levels (n=80), although the difference was not significant (p=0.054). Two patients (3%) without elevated amylase on postoperative day 1 developed postoperative pancreatic fistula (p<0.001) compared to 29 patients (45%) with elevated amylase. Conclusion Normal drain amylase on postoperative day 1 is associated with a lower risk of postoperative complications than is elevated drain amylase. Elevated amylase in the drain fluid on postoperative day 1 is significantly correlated with POPF and is associated with an increased risk of postoperative complications.


Kristina Hasselgren, Pernilla Benjaminsson-Nyberg, Ingvar Halldestam, Marcus Permert Fraser, Thomas Gasslander, Per Sandström, Bergthor Björnsson

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