- Design
- Retrospective single-centre cohort
- Population
- 258 patients after distal pancreatectomy, 2014 to 2024
- Primary outcome
- Clinically relevant postoperative pancreatic fistula
- Effect
- Day-3 amylase 1,000 U/L or more OR 8.21; day-3 CRP 12 mg/dL or more OR 3.37; fistula in 28.3%
A retrospective Japanese series reviewed 258 distal pancreatectomies from 2014 to 2024, with drains at the pancreatic stump and/or left subphrenic space. Clinically relevant postoperative pancreatic fistula developed in 28.3% (73 patients).
On multivariable analysis, drain fluid amylase of 1,000 U/L or more on day 3 (OR 8.21, P < 0.001) and CRP of 12 mg/dL or more on day 3 (OR 3.37, P = 0.004) predicted fistula independently. Laparotomy, older age and longer operating time were also associated. The left subphrenic drain was linked to lower amylase and less fistula than the stump drain, and the authors suggest it may be omitted when an effective stump drain is placed.
This points to a day-3 rule for removing drains in patients with low values, but it was derived and tested in one retrospective cohort and has not been validated prospectively. Use it to support local protocols rather than replace judgement.
- Measure drain fluid amylase and CRP on days 1 and 3 after distal pancreatectomy.
- Consider earlier drain removal when day-3 amylase is below 1,000 U/L and CRP is below 12 mg/dL, with clinical well-being.
- Keep drains longer, and look for a collection, when day-3 values are above those thresholds.
- Consider fewer drains when an effective stump drain is in place.
- Audit your own fistula rate before adopting the thresholds.
Why it matters
It replaces habit-driven drain duration with objective markers that most hospitals already can measure.
Don't overread it
The thresholds come from one retrospective cohort and were not tested in a separate prospective series.
The statistics, in plain English
An odds ratio of 8.21 means those with high day-3 amylase had much higher odds of fistula, but thresholds chosen on the same data tend to look better than they will in new patients. Retrospective data also leave room for confounding by who got which drain.
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