Combination of fistula risk score and drain fluid amylase on postoperative day one to predict clinically relevant postoperative pancreatic fistula following pancreaticoduodenectomy / 中华普通外科杂志

ABSTRACT

Objective:To evaluate combining fistula risk score(FRS) with drain fluid amylase on postoperative day 1(DFA1) in predicting clinically relevant postoperative pancreatic fistula(CR-POPF) following pancreaticoduodenectomy(PD).Methods:The clinical data of 430 patients who underwent PD in the First Affiliated Hospital of Amy Medical University from Jan 2013 to Oct 2015 was retrospectively analyzed, receiver operating characteristic curve(ROC curve) was used to test whether the FRS predicts the CR-POPF, and DFA1 was employed to predict the CR-POPF in the moderate/high subgroup patients(FRS 3-10).Results:Fifty six patients(13.0%) had CR-POPF, the ROC curve for FRS predicting CR-POPF was formed with area under curve 0.894(95% CI 0.861-0.921, P<0.001), the results from univariate and multivariate logistic regression analysis showed that FRS was independent risk factor associated with CR-POPF ( OR=2.933, 95% CI 2.230-3.856, P<0.001). After dividing 430 patients into 2 groups by FRS category, there was no CR-POPF in negligible/low subgroup patients(FRS 0-2), and FRS>2 predicted CR-POPF with negative predictive value 100%; in moderate/high subgroup patients(FRS 3-10), ROC curve worked out DFA1>653.9 U/L predicting CR-POPF well with sensitivity, specificity, positive and negative predictive value of 87.5%, 63.8%, 39.2%, 95.0%, respectively. Conclusion:For patients with FRS≤2, and FRS≥3 accompanying DFA1≤650 U/L, early removal of intra-abdominal drains after PD is safe.