Clinical relevant pancreatic fistula after pancreatoduodenectomy: when negative amylase levels tell the truth

Francesco Giovinazzo, Ralph Linneman, Giulio Valentino Dalla Riva, Daniele Greener, Christopher Morano, Gijs A. Patijn, Mark G. H. Besselink, Vincent B. Nieuwenhuijs, Mohammad Abu Hilal*, Artificial Intelligence Pancreatic Fistula Group, Ignace De Hingh

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

2 Citations (Web of Science)


Drain Amylase level are routinely determined to diagnose pancreatic fistula after Pancreatocoduodenectomy. Consensus is lacking regarding the cut-off value of amylase to diagnosis clinically relevant postoperative pancreatic fistulae (POPF). The present study proposes a model based on Amylase Value in the Drain (AVD) measured in the first three postoperative days to predict a POPF. Amylase cut-offs were selected from a previous published systematic review and the accuracy were validated in a multicentre database from 12 centres in 2 countries. The present study defined POPF the 2016 ISGPS criteria (3 times the upper limit of normal serum amylase). A learning machine method was used to correlate AVD with the diagnosis of POPF. Overall, 454 (27%) of 1638 patients developed POPF. Machine learning excluded a clinically relevant postoperative pancreatic fistulae with an AUC of 0.962 (95% CI 0.940-0.984) in the first five postoperative days. An AVD at a cut-off of 270 U/L in 2 days in the first three postoperative days excluded a POPF with an AUC of 0.869 (CI 0.81-0.90, p < 0.0001). A single AVD in the first three postoperative days may not exclude POPF after pancreatoduodenectomy. The levels should be monitored until day 3 and have two negative values before removing the drain. In the group with a positive level, the drain should be kept in and AVD monitored until postoperative day five.

Original languageEnglish
Pages (from-to)1391-1397
Number of pages7
JournalUpdates in Surgery
Issue number4
Publication statusPublished - Aug 2021


  • RISK

Cite this