Trans-anastomotic stent does not impact the predictive value of drain fluid amylase after pancreatoduodenectomy.

Background

Drain fluid amylase (DFA) guides risk stratification and drain management after pancreatoduodenectomy (PD), but its interpretation in patients with trans-anastomotic stents (TS) remains poorly defined.

Methods

We retrospectively analyzed multicenter PD data, focusing on TS-managed patients. DFA was measured on postoperative days (POD) 1, 3, and 5. The primary outcome was clinically relevant postoperative pancreatic fistula (CR-POPF), with major morbidity (Clavien-Dindo ≥ IIIa) as a secondary outcome. Discrimination was evaluated by adding log-transformed DFA to a baseline model including high-risk PD and center.

Results

Among 1156 patients, 464 (40.1%) received TS. The baseline model yielded an AUC of 0.645, which increased to 0.748 with POD1 log(DFA) and to 0.786 with POD3 log(DFA); POD3 was not significantly different from POD1 (P = 0.056). In complete-case analyses including POD5, POD5 further improved discrimination compared with POD1 (P = 0.008), but was not statistically different from POD3 (P = 0.126). Although median DFA values were higher in TS patients (reflecting a greater prevalence of high-risk PD), DFA dynamics were similar to those of non-TS patients.

Discussion

Early DFA remains informative with TS. Integrating DFA with pre- and intraoperative risk features supports serial risk assessment in the early postoperative period.