Amylase concentration in drainage fluid as a predictive factor for severe postoperative pancreatic fistula in patients with gastric cancer

Taniguchi, Yoshiki; Kurokawa, Yukinori; Mikami, Jota; Miyazaki, Yasuhiro; Makino, Tomoki; Takahashi, Tsuyoshi; Yamasaki, Makoto; Nakajima, Kiyokazu; Takiguchi, Shuji; Mori, Masaki; Doki, Yuichiro

doi:10.1007/s00595-017-1521-y

Cited by 15 publications

(11 citation statements)

References 27 publications

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“…Does this indicate that it has already been generalized not to place an abdominal drain after gastrectomy in Japan? The answer is probably “No.” There are many papers on “drain amylase” and we easily found three recent retrospective studies on the measurement of amylase level in drainage fluid from Japan . As a result of the existence of these papers, it is presumed that an abdominal drain is placed after gastrectomy in many Japanese institutes.…”

Section: Consensus Guidelines For Enhanced Recovery After Gastrectomymentioning

confidence: 99%

“…As a result of the existence of these papers, it is presumed that an abdominal drain is placed after gastrectomy in many Japanese institutes. Although the authors argue that the measurement of amylase level in drainage fluid can predict early detection of pancreatic fistula, there is no evidence that it contributes to improve the patient's short‐term prognosis …”

Section: Consensus Guidelines For Enhanced Recovery After Gastrectomymentioning

confidence: 99%

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Current status of the “enhanced recovery after surgery” program in gastric cancer surgery

Yamagata

Yoshikawa

Yura

et al. 2019

Annals of Gastroent Surgery

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Since the late 1990s, perioperative care through the enhanced recovery after surgery (ERAS, European Society for Clinical Nutrition and Metabolism [ESPEN]) program has spread. ERAS protocols aim to reduce surgical complications, improving postoperative outcomes and thereby saving resources by addressing various clinical elements through a multidisciplinary approach or based on evidence. In the field of gastric cancer, the philosophy of ERAS has gradually become accepted and, in 2014, consensus guidelines for enhanced recovery after gastrectomy were published. These guidelines consist of “procedure‐specific” guidelines and “general (not procedure‐specific) enhanced recovery items.” In this review, we focused on the procedure‐specific guidelines and tried to update the contents of every element of the procedure‐specific guidelines. The procedure‐specific guidelines consist of the following eight elements: “Preoperative nutrition,” “Preoperative oral pharmaconutrition,” “Access (of gastrectomy),” “Wound catheters and transversus abdominis plane block,” “Nasogastric/Nasojejunal decompression,” “Perianastomotic drains,” “Early postoperative diet and artificial nutrition,” and “Audit.” On reviewing papers supporting these elements, it was reconfirmed that the recommendations of the guidelines are pertinent and valid. Four meta‐analyses concerning the evaluation of ERAS protocols for gastric cancer were included in this review. Every study showed that the ERAS protocol reduced the cost and duration of hospital stay without increasing surgical complication rates, suggesting that ERAS is effective for gastric cancer surgery. However, it cannot be said that ERAS has achieved full penetration in Japan because most evidence is established in Western countries. Future studies must focus on developing a new ERAS protocols appropriate to Japanese conditions of gastric cancer.

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Section: Consensus Guidelines For Enhanced Recovery After Gastrectomymentioning

confidence: 99%

Section: Consensus Guidelines For Enhanced Recovery After Gastrectomymentioning

confidence: 99%

Current status of the “enhanced recovery after surgery” program in gastric cancer surgery

Yamagata

Yoshikawa

Yura

et al. 2019

Annals of Gastroent Surgery

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“…In a recent study, it has been believed that drain amylase levels higher than 2000 IU/L on the first postoperative day would serve as a warning sign to predict POPF 4 . In Taniguchi's study 20 , it has been shown that splenectomy is an independent risk factor for POPF and an amylase level of 2100 U/L on POD 3 may be regarded as an early indicator for severe POPF. As opposed to those studies, the measurement of drain amylase level was performed on the second postoperative day in the present study and none of our patients have had drain amylase level more than 2800 IU/L.…”

Section: Discussionmentioning

confidence: 99%

Impact of high amylase level in drainage fluid after gastric cancer surgery: Is it a complication or suspicious biochemical measurement?

Hasbahçeci¹,

Cengiz

Akçakaya

et al. 2019

Cukurova Medical Journal

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Öz Purpose: Pancreatic fistula is a potential postoperative complication with variable definitions, incidences and risk factors. We intended to evaluate its impact after gastric surgery. Materials and Methods: A total of 28 consecutive patients who underwent curative open gastrectomy with lymphadenectomy for gastric adenocarcinoma were retrospectively analyzed. Patients' demographics, perioperative and pathological data were collected. Pancreatic fistula that was diagnosed and graded according to International Study Group of Pancreatic Fistula's system was identified as main variable. Results: Mean age of patients was 58.8±10.1 years with a female to male ratio of 9/19. Grade A pancreatic fistula was diagnosed in six patients (21.4%). There was no grade B and C pancreatic fistula. Drain amylase level was significantly higher in patients with pancreatic fistula. There was no significant difference with regard to amount of drainage, length of hospital stay and duration of drains in patients with and without fistula. No significant association was shown between development of fistula and patients' demographics, peri-operative and pathological data. Conclusion: The development of grade A pancreatic fistula after gastric surgery does not appear to be a major complication with clinical consequences. High amylase level in the drainage fluid can be considered as a biochemical measure only.

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“…When the cutoff level of the dAmy-C on POD3 was set to 375 IU/L, the positive and negative predictive values were lower than those associated with the dAmy-C on POD1 and the A-dAmy on POD1. In past studies, the cutoff levels of the dAmy-C on POD3 were 555–2,000 IU/L [15, 16]. A dAmy-C on POD3 >375 UI/L might not be optimal for predicting ≥ grade II pancreatic fistula after gastrectomy [15, 16].…”

Section: Discussionmentioning

confidence: 99%

“…In past studies, the cutoff levels of the dAmy-C on POD3 were 555–2,000 IU/L [15, 16]. A dAmy-C on POD3 >375 UI/L might not be optimal for predicting ≥ grade II pancreatic fistula after gastrectomy [15, 16].…”

Section: Discussionmentioning

confidence: 99%

The Amount and Concentration of Drain Amylase Together Predict Postoperative Pancreatic Fistula after Gastric Cancer Surgery More Accurately than the Concentration Alone

et al. 2022

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Introduction The drain amylase concentration (dAmy-C) is a useful marker for predicting pancreatic fistula after gastric cancer surgery. However, dAmy-C might be reduced in cases of high drainage volume. Therefore, we hypothesized that we could accurately assess the amount of amylase leaked from the pancreas by multiplying dAmy-C by the daily drainage volume. In this study, we investigated the clinical utility of the amount of drain amylase (A-dAmy: concentration × volume) for predicting pancreatic fistula. And, we investigated the clinical utility of the combination of dAmy-C and A-dAmy for predicting pancreatic fistula. Methods We investigated patients who underwent gastrectomy for gastric cancer at Yodogawa Christian Hospital between 2012 and 2020. The optimal cut-off levels of dAmy-C and A-dAmy on postoperative day 1 for predicting Clavien-Dindo grade II or higher pancreatic fistula were calculated using receiver operating characteristic (ROC) curves. And, we calculate the positive predictive value and negative predictive value for predicting pancreatic fistula using these cut-off levels. Results A total of 448 patients were eligible for analysis. Twenty-two patients experienced Clavien-Dindo grade II or higher pancreatic fistula. ROC curves identified 1,615 IU/L as the optimal cut-off level of dAmy-C predicting pancreatic fistula. When the simple cut-off level of dAmy-C was 1,600 IU/L, the positive predictive value for was 22.8% and the negative predictive value was 99.7%. ROC curves identified 177.52 IU as the optimal cut-off level of A-dAmy predicting pancreatic fistula. When the simple cut-off level of A-dAmy was 177 IU, the positive predictive value was 21.2% and the negative predictive value was 99.7%. Using these two cut-off levels together, the positive predictive value was 34.4% and the negative predictive value was 99.7%. Conclusion A-dAmy could predict and exclude pancreatic fistula after gastrectomy as with dAmy-C. The combination of dAmy-C and A-dAmy predict pancreatic fistula more accurately than dAmy-C alone.

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Amylase concentration in drainage fluid as a predictive factor for severe postoperative pancreatic fistula in patients with gastric cancer

Abstract: Splenectomy was an independent risk factor for severe PPF. An amylase level of 2100 U/L on POD 3 may be a reliable cut-off value for the early diagnosis of patients at high risk of severe PPF.

Cited by 15 publications

References 27 publications

Current status of the “enhanced recovery after surgery” program in gastric cancer surgery

Current status of the “enhanced recovery after surgery” program in gastric cancer surgery

Impact of high amylase level in drainage fluid after gastric cancer surgery: Is it a complication or suspicious biochemical measurement?

The Amount and Concentration of Drain Amylase Together Predict Postoperative Pancreatic Fistula after Gastric Cancer Surgery More Accurately than the Concentration Alone

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