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Drain Amylase Concentrations at 3 h After Gastrectomy Enhance Early Prediction of Postoperative Peripancreatic Inflammatory Fluid Collection

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Abstract

Background

Despite numerous studies of peripancreatic inflammatory fluid collection (PIFC) that report on the relevance of the drain amylase concentration (D-AMY), early prediction using this assay is problematic. This study aimed to investigate the clinical significance of measuring the D-AMY at 3 h after gastrectomy (POD0) for gastric cancer.

Methods

This retrospective analysis included consecutive patients who underwent gastrectomy combined with peripancreatic lymph node dissection. The predictive value of D-AMY on POD0 and postoperative day 1 (POD1) for clinically relevant PIFC was evaluated together or individually.

Results

Analyses were performed in 204 patients. Twenty (9.8%) patients experienced PIFC. D-AMY cutoffs of 721 IU/L on POD0 and 1695 IU/L on POD1 were determined using the receiver operating characteristic curve analysis for predicting PIFC. The D-AMY on POD0 had higher sensitivity (80%) but lower specificity (66.3%) for prediction of PIFC, compared with those of D-AMY on POD1 (65%, 89.1%, respectively). When combination marker analysis was performed, the highest risk group (D-AMY ≥ the cutoff values of POD0 and POD1) were associated with an elevated rate of occurrence (44%) and a high positive likelihood ratio (7.36) compared with those of the single cutoff group. The lowest risk group (D-AMY < the cutoff values on POD0 and POD1) was associated with a low rate of occurrence (2.5%) and low negative likelihood ratio (0.24) compared with those of the single cutoff group.

Conclusions

Combined measurements of D-AMYs on POD0 and POD1 enhanced early prediction of PIFC after gastrectomy.

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Acknowledgements

English editing in a draft of this manuscript was provided by Edanz Group (www.edanzediting.com/ac).

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Authors and Affiliations

  1. Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan

    Koki Nakanishi, Mitsuro Kanda, Chie Tanaka, Shigeomi Takeda, Katsuhito Tanaka, Dai Shimizu, Yoshikuni Inokawa, Norifumi Hattori, Masamichi Hayashi, Goro Nakayama, Michitaka Fujiwara & Yasuhiro Kodera

  2. Department of Medical Equipment and Supplies Management, Nagoya University Hospital, Nagoya, Japan

    Michitaka Fujiwara

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  1. Koki Nakanishi
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  2. Mitsuro Kanda
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  12. Yasuhiro Kodera
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Correspondence to Mitsuro Kanda.

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The authors declare that they have no competing interests.

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All procedures performed were approved by a suitably constituted Ethics Committee of the Nagoya University Hospital (Approval No. 2017-0475) and it conforms to the provisions of the Declaration of Helsinki.

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Nakanishi, K., Kanda, M., Tanaka, C. et al. Drain Amylase Concentrations at 3 h After Gastrectomy Enhance Early Prediction of Postoperative Peripancreatic Inflammatory Fluid Collection. World J Surg 46, 648–655 (2022). https://doi.org/10.1007/s00268-021-06401-z

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  • DOI: https://doi.org/10.1007/s00268-021-06401-z

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