Postoperative elevation of C‐reactive protein levels and high drain fluid amylase output are strong predictors of pancreatic fistulas after distal pancreatectomy

Background The aim of the present study was to identify the predictors of postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP). Methods The records of 97 consecutive patients who underwent DP at Ehime University Hospital between June 2009 and August 2020 were retrospectively reviewed. Patient characteristics, preoperative blood biochemistry data, operative findings, and postoperative findings until postoperative day (POD) 3 were investigated as potential predictors of clinically relevant POPF (CR‐POPF). The product of the drain fluid amylase (DFA) value (U/L) and the drainage amount (mL/day) was defined as DFA output (U/day). Results Of 97 patients who underwent DP, 23 (23.7%) developed CR‐POPF. On multivariate analyses, high C‐reactive protein (CRP) levels on POD 3 (>14.0 mg/dL) and high DFA output on POD 3 (>34 U/day) were found to be independent predictors of CR‐POPF (odds ratios, 7.580 and 4.751, respectively; 95% confidence intervals, 2.052‐27.995 and 1.487‐15.175, respectively). Furthermore, the CRP value was helpful for predicting delayed CR‐POPF in patients without POPF on POD3, and DFA output was useful for predicting the development of CR‐POPF in patients diagnosed with POPF on POD3. Conclusion Postoperative CRP values and DFA output may facilitate appropriate postoperative management after DP. Highlight Sakamoto and colleagues investigated the usefulness of the postoperative C‐reactive protein value and drainage fluid amylase output as predictors of postoperative pancreatic fistula after distal pancreatectomy. The postoperative C‐reactive protein value can predict delayed postoperative pancreatic fistula and the drainage fluid amylase output can differentiate developing fistula from biochemical leak.