Kinetics of postoperative drain fluid amylase values after pancreatoduodenectomy: New insights to dynamic, data-driven drain management.

Published on Apr 9, 2021in Surgery3.982
· DOI :10.1016/J.SURG.2021.02.068
Amer H. Zureikat44
Estimated H-index: 44
(University of Pittsburgh),
Fabio Casciani3
Estimated H-index: 3
(UPenn: University of Pennsylvania)
+ 2 AuthorsCharles M. Vollmer67
Estimated H-index: 67
(UPenn: University of Pennsylvania)
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Abstract
References10
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#1Maxwell T. Trudeau (UPenn: University of Pennsylvania)H-Index: 4
#2Laura Maggino (UPenn: University of Pennsylvania)H-Index: 12
Last. Charles M. Vollmer (UPenn: University of Pennsylvania)H-Index: 67
view all 9 authors...
Abstract Background Intraoperative drain use for pancreatoduodenectomy (PD) has been practiced in an unconditional, binary manner (placement/no-placement). Alternatively, dynamic drain management has been introduced, incorporating the Fistula Risk Score (FRS) and drain fluid amylase (DFA) analysis, to mitigate clinically-relevant pancreatic fistula (CR-POPF). Study Design An extended experience with dynamic drain management was employed at a single institution for 400 consecutive PDs (2014-2019)...
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#1Thomas F. Seykora (UPenn: University of Pennsylvania)H-Index: 6
#2Laura Maggino (UPenn: University of Pennsylvania)H-Index: 12
Last. Charles M. Vollmer (UPenn: University of Pennsylvania)H-Index: 67
view all 8 authors...
Recent data illustrates improved outcomes when adhering to early drain removal following pancreatoduodenectomy (PD). This study aims to explore the potential benefits of expanding the timeframe for early drain removal. Six hundred forty PDs were originally managed by selective drain placement and early removal. Outcomes were reappraised in the framework of a novel proposal; intraoperative drains were omitted based on a low-risk profile (Fistula Risk Score 0–2), followed by drain removal at PODs ...
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#1Matthew T. McMillan (UPenn: University of Pennsylvania)H-Index: 25
#2Giuseppe MalleoH-Index: 46
Last. Charles M. VollmerH-Index: 67
view all 13 authors...
Objective:This multicenter study sought to prospectively evaluate a drain management protocol for pancreatoduodenectomy (PD).Background:Recent evidence suggests value for both selective drain placement and early drain removal for PD. Both strategies have been associated with reduced rates of clinica
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#1Nicole Villafane-Ferriol (BCM: Baylor College of Medicine)H-Index: 6
#2George Van Buren (BCM: Baylor College of Medicine)H-Index: 19
Last. William E. Fisher (BCM: Baylor College of Medicine)H-Index: 60
view all 16 authors...
Abstract Background Although used as criterion for early drain removal, postoperative day (POD) 1 drain fluid amylase (DFA) ≤ 5000 U/L has low negative predictive value for clinically relevant postoperative pancreatic fistula (CR-POPF). It was hypothesized that POD3 DFA ≤ 350 could provide further information to guide early drain removal. Methods Data from a pancreas surgery consortium database for pancreatoduodenectomy and distal pancreatectomy patients were analyzed retrospectively. Those pati...
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#1Claudio BassiH-Index: 111
Last. M.W. Büchler (Heidelberg University)H-Index: 79
view all 33 authors...
Background In 2005, the International Study Group of Pancreatic Fistula developed a definition and grading of postoperative pancreatic fistula that has been accepted universally. Eleven years later, because postoperative pancreatic fistula remains one of the most relevant and harmful complications of pancreatic operation, the International Study Group of Pancreatic Fistula classification has become the gold standard in defining postoperative pancreatic fistula in clinical practice. The aim of th...
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#1Mariano Cesare Giglio (Hammersmith Hospital)H-Index: 13
#2Duncan Spalding (Hammersmith Hospital)H-Index: 19
Last. Madhava Pai (Hammersmith Hospital)H-Index: 21
view all 7 authors...
Background Drain amylase content in the days immediately after major pancreatic resection has been investigated previously as a predictor of postoperative pancreatic fistula (POPF). Its accuracy, however, has not been determined conclusively. The purpose of this study was to evaluate the accuracy of drain amylase content on the first day after major pancreatic resection in predicting the occurrence of POPF. Methods A literature search of the MEDLINE, Embase and Scopus® databases to 13 May 2015 w...
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#1Christina W. Lee (UW: University of Wisconsin-Madison)H-Index: 7
#2Henry A. Pitt (TU: Temple University)H-Index: 61
Last. Sharon M. Weber (UW: University of Wisconsin-Madison)H-Index: 57
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Introduction Improvements in the ability to predict pancreatic fistula could enhance patient outcomes. Previous studies demonstrate that drain fluid amylase on postoperative day 1 (DFA1) is predictive of pancreatic fistula. We sought to assess the accuracy of DFA1 and to identify a reliable DFA1 threshold under which pancreatic fistula is ruled out.
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#1Claudio Bassi (University of Verona)H-Index: 111
#2Enrico MolinariH-Index: 51
Last. Paolo PederzoliH-Index: 83
view all 8 authors...
Summary of Background Data:The role of surgically placed intra-abdominal drainages after pancreatic resections has not been clearly established. In particular, their effect on morbidity rates and the optimal timing for their removal remains controversial.Methods:A total of 114 eligible patients who
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