• Daniel J Moskovic, Sally E Hodges, Meng-Fen Wu, F Charles Brunicardi, Susan G Hilsenbeck, and William E Fisher.
• Michael E DeBakey Department of Surgery and Dan L Duncan Cancer Center, The Elkins Pancreas Center, Baylor College of Medicine, Houston, TX 77030, USA.
• HPB (Oxford). 2010 Sep 1; 12 (7): 472-81.

BackgroundPost-operative pancreatic fistula (POPF) is a common and potentially devastating complication of pancreas resection. Management of this complication is important to the pancreas surgeon.ObjectiveThe aim of the present study was to evaluate whether drain data accurately predicts clinically significant POPF.MethodsA prospectively maintained database with daily drain amylase concentrations and output volumes from 177 consecutive pancreatic resections was analysed. Drain data, demographic and operative data were correlated with POPF (ISGPF Grade: A--clinically silent, B--clinically evident, C--severe) to determine predictive factors.ResultsTwenty-six (46.4%) out of 56 patients who underwent distal pancreatectomy and 52 (43.0%) out of 121 patients who underwent a Whipple procedure developed a POPF (Grade A-C). POPFs were classified as A (24, 42.9%) and C (2, 3.6%) after distal pancreatectomy whereas they were graded as A (35, 28.9%), B (15, 12.4%) and C (2, 1.7%) after Whipple procedures. Drain data analysis was limited to Whipple procedures because only two patients developed a clinically significant leak after distal pancreatectomy. The daily total drain output did not differ between patients with a clinical leak (Grades B/C) and patients without a clinical leak (no leak and Grade A) on post-operative day (POD) 1 to 7. Although the median amylase concentration was significantly higher in patients with a clinical leak on POD 1-6, there was no day that amylase concentration predicted a clinical leak better than simply classifying all patients as 'no leak' (maximum accuracy = 86.1% on POD 1, expected accuracy by chance = 85.6%, kappa = 10.2%).ConclusionDrain amylase data in the early post-operative period are not a sensitive or specific predictor of which patients will develop clinically significant POPF after pancreas resection.

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