Optimal cutoff values of drain amylase for predicting pancreatic fistula are different between open and laparoscopic distal pancreatectomy,Surgical Endoscopy

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Optimal cutoff values of drain amylase for predicting pancreatic fistula are different between open and laparoscopic distal pancreatectomy
Surgical Endoscopy ( IF 3.1 ) Pub Date : 2024-03-25 , DOI: 10.1007/s00464-024-10781-3
Jun Ishida , Hirochika Toyama , Sadaki Asari , Tadahiro Goto , Yoshihide Nanno , Toshihiko Yoshida , Shinichi So , Takeshi Urade , Kenji Fukushima , Hidetoshi Gon , Daisuke Tsugawa , Shohei Komatsu , Hiroaki Yanagimoto , Masahiro Kido , Takumi Fukumoto

Background

Drainage fluid amylase (DFA) is useful for predicting clinically relevant postoperative pancreatic fistula (CR-POPF) after distal pancreatectomy (DP). However, difference in optimal cutoff value of DFA for predicting CR-POPF between open DP (ODP) and laparoscopic DP (LDP) has not been investigated. This study aimed to identify the optimal cutoff values of DFA for predicting CR-POPF after ODP and LDP.

Methods

Data for 294 patients (ODP, n = 127; LDP, n = 167) undergoing DP at Kobe University Hospital between 2010 and 2021 were reviewed. Propensity score matching was performed to minimize treatment selection bias. Receiver operating characteristic (ROC) analysis was performed to determine the optimal cutoff values of DFA for predicting CR-POPF for ODP and LDP. Logistic regression analysis for CR-POPF was performed to investigate the diagnostic value of DFA on postoperative day (POD) three with identified cutoff value.

Results

In the matched cohort, CR-POPF rates were 24.7% and 7.9% after ODP and LDP, respectively. DFA on POD one was significantly lower after ODP than after LDP (2263 U/L vs 4243 U/L, p < 0.001), while the difference was not significant on POD three (543 U/L vs 1221 U/L, p = 0.171). ROC analysis revealed that the optimal cutoff value of DFA on POD one and three for predicting CR-POPF were different between ODP and LDP (ODP, 3697 U/L on POD one, 1114 U/L on POD three; LDP, 10564 U/L on POD one, 6020 U/L on POD three). Multivariate analysis showed that DFA on POD three with identified cutoff value was the independent predictor for CR-POPF both for ODP and LDP.

Conclusions

DFA on POD three is an independent predictor for CR-POPF after both ODP and LDP. However, the optimal cutoff value for it is significantly higher after LDP than after ODP. Optimal threshold of DFA for drain removal may be different between ODP and LDP.

Graphical abstract

中文翻译：

开腹和腹腔镜远端胰腺切除术中引流淀粉酶预测胰瘘的最佳截止值不同

背景

引流液淀粉酶 (DFA) 可用于预测远端胰腺切除术 (DP) 后临床相关的术后胰瘘 (CR-POPF)。然而，尚未研究开放 DP (ODP) 和腹腔镜 DP (LDP) 之间预测 CR-POPF 的 DFA 最佳截止值的差异。本研究旨在确定 ODP 和 LDP 后预测 CR-POPF 的 DFA 最佳截止值。

方法

对 2010 年至 2021 年间在神户大学医院接受 DP的 294 名患者（ODP，n = 127；LDP，n = 167）的数据进行了审查。进行倾向评分匹配以尽量减少治疗选择偏差。进行受试者工作特征 (ROC) 分析以确定 DFA 预测 ODP 和 LDP CR-POPF 的最佳截止值。对 CR-POPF 进行逻辑回归分析，以研究术后第三天 (POD) 的 DFA 的诊断价值，并确定截止值。

结果

在匹配队列中，ODP 和 LDP 后 CR-POPF 率分别为 24.7% 和 7.9%。 ODP 后 POD 1 上的 DFA 显着低于 LDP 后（2263 U/L vs 4243 U/L，p < 0.001），而 POD 3 上差异不显着（543 U/L vs 1221 U/L，p = 0.171）。 ROC 分析显示，POD 1 和 3 上的 DFA 预测 CR-POPF 的最佳截止值在 ODP 和 LDP 之间是不同的（ODP，POD 1 为 3697 U/L，POD 3 为 1114 U/L；LDP，10564 U/L）。 L 在 POD 1 上，6020 U/L 在 POD 3 上）。多变量分析表明，对于 ODP 和 LDP，POD 3 上的 DFA（具有确定的截止值）是 CR-POPF 的独立预测因子。