Vol.:(0123456789) 1 3 Updates in Surgery (2020) 72:727–741 https://doi.org/10.1007/s13304-020-00784-9 ORIGINAL ARTICLE Role of drain amylase levels assay and routinary postoperative day 3 abdominal CT scan in prevention of complications and management of surgical drains after pancreaticoduodenectomy Damiano Caputo 1  · Silvia Angeletti 2  · Massimo Ciccozzi 3  · Mariacristina Cartillone 1  · Chiara Cascone 1  · Vincenzo La Vaccara 1  · Alessandro Coppola 1  · Roberto Coppola 1 Received: 9 March 2020 / Accepted: 2 May 2020 / Published online: 14 May 2020 © Italian Society of Surgery (SIC) 2020 Abstract To asses drains amylase (DA) cut-ofs for the risk of clinically relevant postoperative pancreatic fstula (POPF) and defne the optimal timing of drains removal based on daily DA assay and abdominal CT scan fnding after pancreatoduodenectomy (PD). Diferent algorithms able to identify patients at higher risk of POPF and to assess the optimal time for drains removal after PD have been proposed. The most accurate DA cut-ofs in the assessment of the risk of clinically relevant POPF were retrospectively identifed. Data from a prospective trial for optimal timing of drains removal were analyzed. Then, to vali- date the cut-ofs identifed in the frst phase, they were applied to the patients enrolled in the prospective trial. Patients with POD1 DA ≥ 666 U/L were at higher risk of clinically relevant POPF (p 0.0001). POD3 DA value ≥ 252 U/L predicted 88% of clinical relevant fstulas. POD3 DA level ≥ 207 U/L was able to predict 68% of biliary fstulas. Patients with abdominal collection ≥ 5 cm, showed a signifcantly higher rate (60% vs. 23%, p < 0.001) of biliary fstula. Timing of drains removal did not infuence complications. Drains amylase levels predict clinically relevant POPF. Drains should be maintained up to POD3; in case of POD1 DA levels < 666 U/L and POD3 DA levels < 252 U/L drains could be removed. In case of POD3 DA levels, ≥ 207 the routine use of abdominal CT scan in the same day could be justifed to detect collections ≥ 5 cm and maintain drains beyond the POD3. Keywords Pancreatic surgery · Pancreas anastomosis · Pancreatic fstula · Pancreatic surgery complications · Surgical drains management Introduction Postoperative pancreatic fstula (POPF) represents the Achil- les heel of pancreaticoduodenectomy (PD). Described in up to 40% of cases and despite techni- cal improvement and the development of mini-invasive approaches, POPF remains the most frequent complication and the main cause of postoperative morbidity since it can lead to other even lethal complications (infection, bleeding, abdominal abscesses) [1, 2]. Prolonging the hospital stay and increasing healthcare costs, POPF also has a high economic impact [3]. According to the importance given to diferent character- istics, as the type or the output of the fuid, the level of amyl- ases on the drainage fuid, POPF defnition often changed over the last years [4]. This explains POPF’s wide rate of incidence reported in the literature. The ISGPF—International Study Group on Pancreatic Fistula—to provide an univocal defnition defned POPF as: “leakage, from a surgical or percutaneous drainage, of any measurable quantity of liquid, starting from postoperative day 3 (POD3), with an amylase content three times greater than the upper serum limit” [5]. Nevertheless, based on the impact that POPF has on patient condition, a classifcation of the severity of the fstula * Alessandro Coppola a.coppola@unicampus.it 1 Department of Surgery, University Campus Bio-Medico of Rome, Via Alvaro del Portillo 200, 00128 Rome, Italy 2 Unit of Clinical Laboratory Science, University Campus Bio-Medico of Rome, Rome, Italy 3 Unit of Medical Statistic and Molecular Epidemiology, University Campus Bio-Medico of Rome, Rome, Italy