T. Adachi1, S. Ono1, T. Adachi1, M. Yamashita1, T. Hara1, A. Soyama1, M. Hidaka1, K. Kanetaka1, M. Takatsuki1, S. Eguchi1 1Nagasaki University,Department Of Surgery,Nagasaki, , Japan
Introduction: A high drain amylase level is a well known predictive marker for the development of a pancreatic fistula (PF) after a pancreaticoduodenectomy (PD). Any sign of PF following a PD warrants immediate preventive measures to avoid the development of PF. We aimed to determine the efficacy of a triple-drug therapy (TDT) regimen using gabexate mesilate, octreotide, and carbapenem antibiotics to prevent PF in patients showing a high drain amylase level on postoperative day (POD1) after PD.
Methods: We enrolled 183 patients who had undergone a PD from the year 2007. Patients were divided into two groups based on the study period. The former period group (2007~2011, n = 81) included patients in whom no particular treatment had been administered even if their drain amylase level on POD1 was high ( ≥ 10,000 IU/L). The latter period group (n = 102) included patients having a high drain amylase level on POD1, who had received TDT [gabexate mesilate 600 mg/day continuous intravenous (civ.), octreotide 150 µg/day civ., and carbapenem 1.0 g/day IV] along with a fasting status in one week. Any other postoperative management including the day of drain removal (POD5) was same in this study period. The primary endpoint was the incidence of PF [beyond grade B defined by the International Study Group of Pancreatic Fistula (ISGPF criteria)].
Results: Incidence of PF in all enrolled patients was 10.9%. Incidence of high drain amylase level ( ≥ 10,000 IU/L) on POD1 in the former group was 11.1% and in the latter group was 17.6%. Incidence of PF in patients whose drain amylase level was not high ( ? 10,000 IU/L) was equivalent (8.2 vs. 4.8%, p = 0.36), between the two groups; however incidence of PF in patients with a high drain amylase level in the latter group was effectively prevented by administration of TDT showing results that were statistically significant (88.9 vs. 11.1%, p ? 0.001).
Conclusion: TDT is an effective treatment strategy to prevent PF even in patients with a high drain amylase level after a PD procedure.