부산대학교 도서관

Byline: M. C. Giglio, D. R. C. Spalding, A. Giakoustidis, A. Zarzavadjian Le Bian, L. R. Jiao, N. A. Habib, M. Pai Abstract Background Drain amylase content in the days immediately after major pancreatic resection has been investigated previously as a predictor of postoperative pancreatic fistula (POPF). Its accuracy, however, has not been determined conclusively. The purpose of this study was to evaluate the accuracy of drain amylase content on the first day after major pancreatic resection in predicting the occurrence of POPF. Methods A literature search of theMEDLINE, Embase and Scopus.sub.[R] databases to 13 May 2015 was performed to identify studies evaluating the accuracy of drain amylase values on day 1 after surgery in predicting the occurrence of POPF. The area under the hierarchical summary receiver operating characteristic (ROC) curve (AUC.sub.hSROC) was calculated as an index of accuracy, and pooled estimates of accuracy indices (sensitivity and specificity) were calculated at different cut-off levels. Subgroup and meta-regression analyses were performed to test the robustness of the results. Results Thirteen studies involving 4416 patients were included. The AUC.sub.hSROC was 0ae89 (95 per cent c.i. 0ae86 to 0ae92) for clinically significant POPF and 0ae88 (0ae85 to 0ae90) for POPF of any grade. Pooled estimates of sensitivity and specificity were calculated for the different cut-offs: 90-100units/l (0ae96 and 0ae54 respectively), 350units/l (0ae91 and 0ae84) and 5000units/l (0ae59 and 0ae91). Accuracy was independent of the type of operation, type of anastomosis performed and octreotide administration. Conclusion Evaluation of drain amylase content on the first day after surgery is highly accurate in predicting POPF following major pancreatic resection. It may allow early drain removal and institution of an enhanced recovery pathway. CAPTION(S): FigS1 Results of the study quality assessment by the QUADAS-2 tool. Left: The proportion of studies with low, high or unclear risk of bias is shown for each domain. Right: The proportion of studies with low, high or unclear concerns regarding applicability is shown for each domain FigS2 Relationship between the cut-off used in the study and estimated values of sensitivity (diamonds) and specificity (circles). The two regression lines show the opposite directions of correlations: the lower the cut-off, the higher the sensitivity (continuous line); the higher the cut-off, the higher the specificity (dotted line) FigS3 Forest plot of the pooled sensitivity and specificity of drain amylase values (DAVs) on postoperative day (POD) 1 in the prediction of postoperative pancreatic fistula of any grade at different cut-off levels: (a) 90-100units/l (grouped analysis); (b) 350units/l; (c) 5000units/l AppendixS1 Electronic search strategy for MEDLINE TableS1 Characteristics of included studies TableS2 Summary of reported values for accuracy of amylase drain content on postoperative day 1 in predicting postoperative pancreatic fistula TableS3 Results of univariable random-effects meta-regression analysis to test the potential effect of co-variables on drain amylase accuracy