Intra-operative amylase concentration in peri-pancreatic fluid predicts pancreatic fistula after distal pancreatectomy

Christopher B. Nahm, Philip R. de Reuver, Thomas J. Hugh, Andrew Pearson, Anthony J. Gill, Jaswinder S. Samra, Anubhav Mittal*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

11 Citations (Scopus)


Post-operative pancreatic fistula (POPF) is a potentially severe complication following distal pancreatectomy. The aim of this study was to assess the predictive value of intra-operative amylase concentration (IOAC) in peri-pancreatic fluid after distal pancreatectomy for the diagnosis of POPF. Consecutive patients who underwent a distal pancreatectomy between November 2014 and September 2016 were included in the analysis. IOAC was measured, followed by drain fluid analysis for amylase on post-operative days (PODs) 1, 3, and 5. Receiver operator characteristic (ROC) analysis was performed to evaluate the discriminative capacity of IOAC as a predictor of POPF. IOAC was measured after distal pancreatectomy in 26 patients. The IOAC correlated significantly with (i) PODs 1, 3, and 5 drain amylase (p < 0.01); (ii) the development of POPF (p < 0.01); and (iii) the Clavien-Dindo grade of surgical complications (p = 0.02). Eighty-three percent of patients with an IOAC > 1000 experienced a post-operative complication (OR 18.3, 95% CI 2.51–103, p < 0.01). ROC curve analysis confirmed the predictive relationship of IOAC and POPF as an excellent test with an area under the curve of 0.92 (95% CI 0.81–0.99, p < 0.01). Measurement of IOAC allows early and accurate categorization of patients at risk for POPF in distal pancreatectomy.

Original languageEnglish
Pages (from-to)1031-1037
Number of pages7
JournalJournal of Gastrointestinal Surgery
Issue number6
Publication statusPublished - Jun 2017
Externally publishedYes


  • Amylase
  • Pancreas
  • Pancreatectomy
  • Pancreatic fistula


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