Title: Evaluation of Intra-Operative Peri-Pancreatic Fluid Amylase Concentration in Predicting Postoperative Pancreatic Fistula after Pancreaticoduodenectomy
Abstract: Introduction: Postoperative pancreatic fistula (POPF) occurs one in every four to seven patients after pancreaticoduodenectomy (PD). POPF causes significant morbidity and mortality. We assessed the predictive value of Intra-operative Amylase concentration (IOAC) of peri-anastomotic fluid collected during surgery for the development of a POPF after PD. Method: All patients who underwent PD at our centre (a tertiary care hospital) between April 2018 and May 2021 were included. IOAC and postoperative day-3 drain fluid amylase values were measured, and occurrence of clinically relevant POPF (CR-POPF) was noted. Receiver Operating Characteristic analysis was used to evaluate the predictive capacity of IOAC for CR-POPF. Results: The study included 64 patients. Clinically relevant POPF was seen in 12 patients (18.8%) of patients. On ROC analysis, Area Under the Curve (AUC) was 0.912 (95% CI: 0.822 to 1.001, p< 0.001). A cut-off IOAC value of 236 IU/L was derived. There was a statistically significant correlation of IOAC value with the occurrence of CR-POPF, with a sensitivity of 91.7% for IOAC above this cut-off value (p<0.001). Conclusion: IOAC is an early predictor for the development of clinically relevant POPF after pancreaticoduodenectomy. Keywords: Intra-operative amylase concentration, Postoperative pancreatic fistula, pancreaticoduodenectomy