Abdominal Drainage and Amylase Measurement for Detection of Leakage After Gastrectomy for Gastric Cancer

Schots, Judith P M; Luyer, Misha; Nieuwenhuijzen, Grard A. P.

doi:10.1007/s11605-018-3789-7

Cited by 16 publications

(18 citation statements)

References 37 publications

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“…Study characteristics of the included studies are shown in Table 1. The role of systemic biomarkers was evaluated separately in fifteen studies, [32,33,34,35,36,37,38,39,40,41,42,43,44,45,46] drain fluid in nine [33,44,45,46,47,48,49,50,51], combined scoring systems in three studies [35,41,52], and mediastinal microdialysis [53], urine volatile organic compounds [54] and respiratory index [40] were all evaluated in one study. All studies except three [37,53,54] were retrospective.…”

Section: Resultsmentioning

confidence: 99%

“…Various definitions of AL were found in the included studies, as shown in Table 2. Six studies [40,42,43,45,49,50] did not mention the median or range concerning the day of AL diagnosis. In the remaining eighteen studies AL was diagnosed with a median on POD 7, ranging between 1 and 30 days.…”

Section: Resultsmentioning

confidence: 99%

“…CRP was evaluated in twelve studies [32,34,35,36,37,39,40,41,42,44,45,50], with a total of 1818 patients—of whom, 243 developed AL. In eight of these studies [32,34,36,37,39,41,42,44] CRP was found significant in predicting AL.…”

Section: Resultsmentioning

confidence: 99%

“…Amylase derived from peritoneal drain fluid was evaluated in nine studies [33,45,46,47,48,49,50,51,55], with a total of 654 patients—of whom, 73 developed AL. Levels of amylase were measured on POD 1–10.…”

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Systematic Review of the Role of Biomarkers in Predicting Anastomotic Leakage Following Gastroesophageal Cancer Surgery

Mooij

Brink

Merry

et al. 2019

JCM

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Anastomotic leakage (AL) following gastroesophageal cancer surgery remains a serious postoperative complication. This systematic review aims to provide an overview of investigated biomarkers for the early detection of AL following esophagectomy, esophagogastrectomy and gastrectomy. All published studies evaluating the diagnostic accuracy of biomarkers predicting AL following gastroesophageal resection for cancer were included. The Embase, Medline, Cochrane Library, PubMed and Web of Science databases were searched. Risk of bias and applicability were assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) 2 tool. Twenty-four studies evaluated biomarkers in the context of AL following gastroesophageal cancer surgery. Biomarkers were derived from the systemic circulation, mediastinal and peritoneal drains, urine and mediastinal microdialysis. The most commonly evaluated serum biomarkers were C-reactive protein and leucocytes. Both proved to be useful markers for excluding AL owing to its high specificity and negative predictive values. Amylase was the most commonly evaluated peritoneal drain biomarker and significantly elevated levels can predict AL in the early postoperative period. The associated area under the receiver operating characteristic (AUROC) curve values ranged from 0.482 to 0.994. Current biomarkers are poor predictors of AL after gastroesophageal cancer surgery owing to insufficient sensitivity and positive predictive value. Further research is needed to identify better diagnostic tools to predict AL.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Systematic Review of the Role of Biomarkers in Predicting Anastomotic Leakage Following Gastroesophageal Cancer Surgery

Mooij

Brink

Merry

et al. 2019

JCM

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“…Moreover, randomization was never mentioned in one of the four articles, classi ed as RCTs. After 2015 other retrospective studies have been published, but most of them included small number of patients and heterogeneous types of surgery, including multi-visceral and R2 resection [5,6,7,8]. Our study group recently published an updated metanalysis including both RCTs and cohort studies comparing the use of prophylactic drain with drain avoidance [9].…”

Section: Background and Rationalementioning

confidence: 99%

Utility of Abdominal Drain in Gastrectomy (ADiGe) Trial: study protocol for a multicenter non-inferiority randomized trial

Weindelmayer

Mengardo

Veltri

et al. 2020

Preprint

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Background: Prophylactic use of abdominal drain in gastrectomy has been questioned in the last 15 years and a 2015 Cochrane meta-analysis on four RCTs concluded that there was no convincing evidence to the routine drain placement in gastrectomy. Nevertheless the Authors evidenced the moderate/low quality of the included studies and highlighted how 3 out of four came from Eastern countries. After 2015 only retrospective studies have been published, all with inconsistent results.Methods: ADiGe (Abdominal Drain in GastrEctomy) Trial is a multicenter prospective randomized non-inferiority trial with a parallel design. It aimed to verify whether avoiding routine use of abdominal drain is burdened with complications, particularly an increase in postoperative invasive procedures. Patients with gastric cancer, scheduled for subtotal or total gastrectomy with curative intent, are eligible for inclusion, irrespective of previous oncological treatment. The primary composite endpoint is reoperation or percutaneous drainage procedures within 30 postoperative days. The primary analysis will verify whether the incidence of the primary composite endpoint is higher in the experimental arm, avoiding routine drain placement, than control arm, undergoing prophylactic drain placement, in order to falsify or support the null hypothesis of inferiority. Secondary endpoints assessed for superiority are overall morbidity and mortality, Comprehensive Complications Index, incidence and time for diagnosis of anastomotic and duodenal leaks, length of hospital stay, readmission rate.Assuming one-sided alpha of 5%, and cumulative incidence of the primary composite endpoint of 14.5% in control arm and 9% in the experimental one, 256 patients allow to achieve 80% power to detect a non-inferiority margin difference between the arm proportions of 4.5%. Considering a 15.5% drop-out rate, 304 patients are needed. In order to have a balanced percentage between total and subtotal gastrectomies, recruitment will end at 152 patients for each type of gastrectomy. The surgeon and the patient are blinded until the end of the operation, while postoperative course is not blinded to patient and caregivers.Discussion: ADiGe Trial could contribute to critically re-evaluate the role of prophylactic drain in gastrectomy, a still widely used procedure.Trial registration: Retrospectively registered on 01/10/2020 at Clinicaltrials.gov with the identifier NCT04227951, https://clinicaltrials.gov/ct2/show/NCT04227951.

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Should we still use prophylactic drain in gastrectomy for cancer? A systematic review and meta-analysis

Weindelmayer

Mengardo

Veltri

et al. 2020

European Journal of Surgical Oncology

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Abdominal Drainage and Amylase Measurement for Detection of Leakage After Gastrectomy for Gastric Cancer

Abstract: Daily amylase measurement in drain fluid does not influence the early recognition and management of leakage in gastric cancer surgery.

Cited by 16 publications

References 37 publications

Systematic Review of the Role of Biomarkers in Predicting Anastomotic Leakage Following Gastroesophageal Cancer Surgery

Systematic Review of the Role of Biomarkers in Predicting Anastomotic Leakage Following Gastroesophageal Cancer Surgery

Utility of Abdominal Drain in Gastrectomy (ADiGe) Trial: study protocol for a multicenter non-inferiority randomized trial

Should we still use prophylactic drain in gastrectomy for cancer? A systematic review and meta-analysis

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