Intraoperative Body Fluid Amylase as a Novel Indicator of Postgastrectomy Pancreatic Fistula

Abstract

Background Although many methods to prevent the development of postoperative pancreatic fistula (POPF) after gastrectomy have been reported, POPF can only be identified after it has occurred. Various therapeutic measures could be taken if signs of POPF could be detected intraoperatively. Methods We conducted a prospective study in which we attempted to predict POPF by measuring the intraoperative amylase concentration in the peripancreatic body fluid. To collect the body fluid, three sponges were placed around the pancreas at lymph node station Nos. 6, 8, and 11 during lymphadenectomy. The amylase concentration was measured in the body fluid squeezed from the sponges. We investigated whether the intraoperative body fluid amylase concentration (IBAC) was associated with POPF formation. Results In total, 109 patients were enrolled from February 2016 to March 2018, and we analyzed 81 eligible patients. Clavien-Dindo grade C II POPF occurred in eight patients (9%). The IBAC was significantly higher in sponges No. 6(P = 0.044) and No. 8 (P = 0.007). The incidence of POPF was predicted by using an IBAC cutoff value for No. 6 (1047 IU/L; sensitivity 87.5%; specificity 65.0%; positive likelihood ratio 2.5) and No. 8 (400 IU/L; sensitivity 87.5%; specificity 68.5%; positive likelihood value 2.8), respectively. The IBAC in sponge No. 11 tended to be higher (P = 0.054). Conclusions By measuring the IBAC, surgeons might predict POPF easily and noninvasively during surgery. This method is one of the most effective ways to predict POPF intraoperatively.

Abdominal drain amylase on the first day after pancreatectomy: a predictive factor for pancreatic fistula

“…Several studies evaluated AD1PO as a predictive factor in the diagnosis of the exclusion of PF-CR [6][7][8][9][10][11][12] to select patients at a low risk of developing this complication, and to remove abdominal drains in the first postoperative days [13][14] . Studies show favorable results and demonstrate that it can be used as a predictive factor in this situation; however, the cutoff points between studies have been quite variable.…”

“…The considerable incidence of PF-CR has prompted other studies to find clinical and laboratory criteria predictive of which patients would evolve or would not with this complication. In this scenario the amylase from the drain on the first postoperative day (AD1PO) stands out, in which research has been carried out to investigate whether this parameter can be used as a tool in the diagnostic exclusion of this complication, and thus asses the removal of the abdominal drain in the first postoperative [6][7][8][9][10][11][12] days of. This practice, which has already been performed in some institutions, is associated with lower rates of intra-abdominal and pulmonary complications, length of hospital stay, and lower hospital costs 13,14 .…”