The Significance of Drain Amylase Level for Diagnosis of Pancreatic Leakage after Pancreatoduodenectomy

ABSTRACT

PURPOSE: Pancreatoduodenectomy is a common procedure for periampullary cancer, but pancreatic leakage is the most dreaded complication after pancreatoduodenectomy. The aim of our study was to evaluate the correlation between the level of amylase in the drain fluid and the level of development of the complications that are related to pancreatic leakage after pancreatoduodenectomy. METHODS: Fifty-one consecutive patients who underwent pancreatoduodenectomy and pancreaticojejunostomy by two surgeons between January 1998 and August 2002 were evaluated retrospectively. A pancreaticojeunotomy was performed by intussuscepting end-to-end anastomosis with an internal stent. Amylase level of the drain fluid was checked every 2 days (postoperative 1, 3, 5, 7 day). Synthetic somatostatin was infused postoperatively for 7 days. RESULTS: The mean age of the 51 patients was 64.8 years, and the male to female ratio was 1.4 1. The classification by pathologic diagnoses were 20 cases of common bile duct cancer (39%), 19 cases of pancreas head cancer (38%), 6 cases of chronic pancreatitis (12%), 4 cases of ampullar of Vater cancer (8%), and 2 cases of duodenal cancer (4%). There were 24 (47%) postoperative complications. Of these complications, the most occurring complication was the 5 (10%) cases of delayed gastric emptying. The other complications were 4 (8%) cases of pancreaticojejunostomy leakage, 4 (8%) cases of intraabdominal abscess, wound infection, and pulmonary complications. The patients were divided into a complication group related to pancreatic leakage and a non-complication group. There were 14 cases allocated to the complication group, and 37 cases were allocated to the non-complication group. The level of amylase in the drain fluid was higher in the complication group (P<0.05). Four cases of pancreaticojejunostomy leakage developed after pancreatoduodenectomy. All cases had symptoms of high fever, leukocytosis, and abdominal tenderness. CONCLUSION: The occurrence of complications related to pancreaticojejunostomy leakage is suspected if the level of amylase in the drain fluid is higher than the normal serum amylase level after 5 days post operation, and fever, leukocytosis, or abdominal tenderness were the typical complication symptoms.