ArticleCureus2026
Association Between Postoperative Pancreatitis and Clinically Relevant Postoperative Pancreatic Fistula After Pancreaticoduodenectomy: A Prospective Observational Study From a Single Tertiary Care Center.
Article in Cureus, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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6 authors.
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Abstract
BACKGROUNDS/
aimsPostoperative pancreatic fistula remains a key determinant of morbidity following pancreaticoduodenectomy (PD). This study assessed whether postoperative day 1 (POD 1) serum amylase (SA) and drain fluid amylase (DFA) can predict clinically relevant postoperative pancreatic fistula (CR-POPF) to facilitate early risk-stratified postoperative management.
methodsThis prospective observational cohort study (January 2021-April 2023) included adult patients undergoing PD with duct-to-mucosa pancreaticojejunal anastomosis. SA and DFA levels were measured on POD 1, POD3, and POD 5. The primary outcome was CR-POPF, defined according to the 2016 International Study Group of Pancreatic Surgery criteria. Receiver operating characteristic (ROC) analyses were performed to identify optimal POD 1 cutoff values.
resultsAmong 57 patients, nine (15.8%) developed CR-POPF. Mean POD 1 SA and DFA levels were significantly higher in patients who developed CR-POPF compared with those who did not (SA: 464 ± 164 vs 262 ± 176 IU/L, p = 0.002; DFA: 12,664 ± 8,800 vs 1,045 ± 1,128 IU/L, p < 0.001). POD 1 SA demonstrated an AUC of 0.803 (95% CI 0.677-0.897), with an optimal cutoff of 363 IU/L (sensitivity 77.78%, specificity 75.0%, negative predictive value (NPV) 94.7%). POD 1 DFA showed superior discrimination with an AUC of 0.889 (95% CI 0.778-0.957); a cutoff of 3,011 IU/L yielded a sensitivity of 66.67%, specificity of 97.92%, positive predictive value (PPV) of 85.7%, and NPV of 94.0%. A dilated pancreatic duct (>3 mm) was inversely associated with CR-POPF (p < 0.001).
conclusionsPOD 1 SA and DFA levels provide a reliable early prediction of CR-POPF following PD. A DFA threshold above 3,011 IU/L demonstrates high specificity for CR-POPF, whereas a SA level ≤363 IU/L effectively excludes its occurrence. Incorporation of these parameters into postoperative protocols may aid early drain management decisions and targeted intervention in high-risk patients.
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