Total Drain Fluid Amylase Values Over Time Correlate with Late Complications of Pancreatic Fistulas after Gastrectomy

Abstract

Introduction:The appropriate management of postoperative pancreatic fistula (POPF) after gastrectomy is believed to decrease the incidence of subsequent complications. Previous reports have indicated a relationship between subsequent complications of POPF and drain fluid amylase levels (D-AMY), but this indicator did not offer adequate sensitivity and specificity. In this study, we searched for indicators using highly precise D-AMY levels to predict the onset of subsequent complications. Materials and methods:We performed a retrospective study of 377 patients who underwent gastrectomy between 2014 and 2020 and whose D-AMY levels were measured. D-AMY levels were measured once a day, and we initiated treatment for pancreatitis if levels were ≥ 1500 U/L. We compared the incidence of complications and various clinical factors, including D-AMY level, and also strove to determine a clinically useful cut-off value. Results: There were 64 patients (17.0%) who were diagnosed as having pancreatitis by D-AMY levels ≥ 1500 U/L and required treatment. The significant risk factors were D-AMY ≥ 766 U/L on postoperative day (POD) 2 (p=0.0415, OR=32.46), and a total D-AMY of ≥ 6801 U/L from POD 0 to POD 4 (p=0.0023, OR=55.85). The area under the receiver operator characteristics curve, sensitivity and specificity were 0.84511, 78.6% and 90.9%, and 0.96834, 82.4% and 96.7% for the POD 2 and POD 0-4 cut-off values, respectively. Conclusion:The POD 2 cut-off value correlated with POPF complications after gastrectomy, but the concomitant use of the cut-off value for the period from POD 0-4 facilitated even more accurate prediction of subsequent onset of complications.