DOES POSTOPERATIVE SERUM LIPASE PREDICT PANCREATIC FISTULA AFTER PANCREATICODUODENECTOMY?

Introduction Pancreatic fistula (POPF) is the most important cause of morbidity and mortality after pancreaticoduodenectomy (PD). Few data are available to stratify the postoperative risk of developing this complication. The aim of this study was to evaluate the role of serum lipase concentration on postoperative day 1 (POD1) as a predictive factor of the development of pancreatic fistula (PF). Materials and methods We retrospectively analyzed data from 89 consecutive PD between January 2009 and December 2013 in order to analyze the association between serum lipase concentration on POD1 and the development of PF . Results 27 patients (30%) developed POPF (Grade A 16 (18%), Grade B 8 (9%), Grade C 3 (3%). Serum lipase were strongly associated with developing of the PF (p<0,001). Receiver operating characteristic (ROC) analysis identified a threshold value of POD1 serum lipase associated with clinically significant POPF (AUC = 0.754, 95% CI 0.64-0.87, p = 0.01) The threshold value of POD1 serum lipase for the identification of clinically significant POPF was ≥44,5 IU/l. Sensitivity and specificity of a postoperative serum lipase >44,5 IU/l was 90% and 65%, respectively. Positive and negative predictive values were 29% and 98 %, respectively. Conclusion Serum lipase concentration on POD1 may be used, in addition to other prognostic factors, to help stratify risk for developing PF following PD. Serum lipase POD1 ≥44,5 IU/l allows for the early and accurate categorization of patients at low risk for clinically significant POPF and may identify patients suitable for post-operative fast track program with significant clinical and economic benefits.