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ID: 422 (Conflict of Interest: K)

Postoperative Pankreasfisteln können bei Patienten ohne intraabdominelle Drainage verlässlich durch die Bestimmung von Serum Amylase und Lipase an Tag 1 und CRP an Tag 4 ausgeschlossen werden

F. J.Hüttner1, A. T.Billeter1, M.Feißt1, S.Kißenkötter2, O.Radulova-Mauersberger2, H.Witzigmann2, M. W.Büchler1, M. K.Diener1
1Universitätsklinikum Heidelberg, Heidelberg
2Städtisches Klinikum Dresden, Dresden

Einleitung

A recent randomized controlled trial showed that pancreatic resections with a pancreaticojejunal anastomosis can be safely performed without routine drainage. However, without an intra-abdominal drain, surgeons lack a diagnostic tool to preclude postoperative pancreatic fistula (POPF) and other surgical complications, which is key to early discharge in modern fast-track concepts. Therefore, the objective of the current analysis was to assess the diagnostic value of CRP, white blood cells (WBC), amylase and lipase after pancreatic surgery.

Material und Methoden

Within a randomized controlled trial comparing routine drainage to no drainage in a total of 395 patients (202 drain / 193 no drain) CRP, WBC, serum amylase and lipase values were prospectively collected preoperatively and on PODs 1, 2, 4 and 10. Diagnostic accuracy was assessed by the area under the curve (AUC) applying the receiver-operating characteristics methodology.

Ergebnisse

A total of 165 patients (41.8%) experienced surgical complications, 36 (9.1%) developed POPF and 78 (19.8%) developed fistula-associated complications. There was no difference in CRP, WBC, amylase or lipase values between patients with and without drainage. CRP value on POD 4 showed the best diagnostic accuracy for the detection of POPF particularly in cases without a drain (AUCCRP 0.78, 95% CI 0.68 – 0.90) with an optimal (Youden’s index) cutoff of 123 mg/l. Furthermore, serum amylase with an optimal cutoff > 160 U/l and lipase > 207 U/l on POD 1 showed good diagnostic accuracy (AUCamyl 0.76 [0.67-0.85]; AUClip 0.77 [0.66-0.88]). The negative predictive value regarding POPF for CRP on POD 4 as well as amylase and lipase on POD 1 in the group without a drain was 1.0 (0.95-1.0). AUC values regarding overall surgical complications or fistula-associated complications were all lower than 0.75 and were thus not further explored.

Schlussfolgerung

Serum amylase and lipase on POD 1 and CRP level on POD 4 can aid in the implementation of modern fast-track concepts in pancreatic surgery. In patients without an intra-abdominal drain after pancreatic resection with a pancreaticojejunal anastomosis lower values than the above mentioned cutoffs reliably preclude POPF, whereas higher values should raise the surgeon’s attentiveness for POPF or other surgical complications.