Review
Copyright ©The Author(s) 2022.
World J Gastrointest Surg. Oct 27, 2022; 14(10): 1089-1106
Published online Oct 27, 2022. doi: 10.4240/wjgs.v14.i10.1089
Table 1 Drain amylase accuracy evaluated beyond sensitivity and specificity
Ref.Cut-off (U/L)Predictive
Evaluated (POD)Patients
SurgeryCR-POPF (%)Study designPublication
Performance
n
Giovinazzo et al[48], 2018350AUC = 0.921568PDNSRAbstract
Partelli et al[49], 2017500AUC = 0.881, OR = 21.721463PD13.82RAbstract
Kerem et al[50], 20181363AUC = 0.911135PD13.33RAbstract
Kawai et al[51], 20095000P = 0.1002 (univariate)1244PD28RFull paper
Teixeira et al[52], 2018< 270Higher median values statistically predicted CR-POPF1102PD25.5PFull paper
271-5000
> 5000
Mimura et al[53], 20122000AUC = 0.811240PD23.4RAbstract
Mimura et al[53], 2012100AUC = 0.865240PD23.4RAbstract
Kawaida et al[54], 2018860P = 0.002 (univariate)375DP9.3PFull paper
Recreo Baquedano et al[55], 2019< 400NPV = 0.9683278PD14PAbstract
Newhook et al[56], 202049Sensitivity = 1145DP24PFull paper
Newhook et al[56], 202026Sensitivity = 1345DP24PFull paper
van Dongen et al[57], 2021100Sensitivity = 12285PD18.24RAbstract
Table 2 Investigations of drain culture across different pancreatic surgery cohorts
Clinical condition
Pancreatoduodenectomy patients
Distal pancreatectomy patients
Present in CR-POPF patientsFungi, gram-positive bacteria, Acinetobacter, Stenotrophomonas, Citrobacter spp, Staphylococcus, Enterococcus, Enterococcus faecalis Candida spp., Klebsiella, Klebsiella pneumoniae, Pseudomonas, Pseudomonas aeruginosa, Escherichia coli, Enterobacter cloacaeFungi, Staphylococcus, Enterococcus, Pseudomonas, Acinetobacter, Stenotrophomonas, Escherichia coli and Klebsiella spp
Predictor of CR-POPFPolymicrobial infections, Candida
Predictor of grade CGram-negative rods, Candida
Table 3 Recommendations for future research
Drain biomarker
To investigate
To confirm
AmylaseAccuracy of intraoperative predictive cut-offs in pancreatoduodenectomy patientsDiagnostic accuracy of proposed cut-offs
Accuracy of POD2 cut-offs in distal pancreatectomy patientsThe change in postoperative drain amylase required to be predictive of CR-POPF in pancreatoduodenectomy patients
Accuracy of POD4 cut-offs in surgery specific cohortsIf a persistently high value for drain amylase x drain volume postoperatively is predictive of CR-POPF
Accuracy of risk-stratified cut-offs in distal pancreatectomy patients
The change in postoperative drain amylase required to be predictive of CR-POPF in distal pancreatectomy patients
When drain amylase has the highest predictive accuracy
LipaseThe change in postoperative drain lipase required to be predictive of CR-POPF in surgery specific cohorts and its accuracyDiagnostic accuracy of proposed cut-offs
The accuracy of predictive cut-offs before POD3 in surgery specific cohortsDiagnostic value of drain lipase in multi-factorial predictive models
Accuracy of risk-stratified cut-offs in surgery specific cohortsWhen drain amylase has the highest predictive accuracy
Drain cultureBacteria within polymicrobial drain fluid samples which predict grade B and C POPF in surgery specific cohortsClinical relevance of Enterobacter, Enterococcus and Staphylococcus to CR-POPF risk in pancreatoduodenectomy patients
When particular microorganisms are most predictive of CR-POPF
The concentrations of high-risk bacteria that accurately predict CR-POPF in surgery specific cohorts
Other biomoleculesAccuracy of predictive cut-offs for each biomarker in surgery specific cohorts
Accuracy of novel enzymes compared to drain amylase and lipase in matched surgical cohorts and PODs
Fluid appearanceAccuracy on specific days before POD3