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

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Purpose

To investigate the value of daily measurement of drain amylase for detecting leakage in gastric cancer surgery.

Methods

This was a retrospective analysis including all patients who underwent a gastrectomy for gastric cancer. From January 2013 until December 2015, an intra-abdominal drain was routinely placed. Drain amylase was measured daily. Receiver operator characteristic curves were created to assess the ability of amylase to predict leakage. Sensitivity, specificity, and negative and positive predictive value of amylase in drain fluid were determined. Leakage of the gastrojejunostomy or esophagojejunostomy, enteroenterostomy, duodenal stump, or pancreas was diagnosed by CT scan, endoscopy, or during re-operation. From January 2016 until April 2017, no drain was inserted. Surgical outcome and postoperative complications were compared between both groups.

Results

Median drain amylase concentrations were higher for each postoperative day in patients with leakage. The optimal cutoff value was 1000 IU/L (sensitivity 77.8%, specificity 98.2%, negative predictive value 96.6%). Sixty-seven consecutive procedures were performed with a drain and 40 procedures without. No differences in group characteristics were observed except for gender. Fourteen patients (13.1%) had a leakage. The incidence and severity of leakage were not different between the patients with and without a drain. There was no significant difference in time to diagnosis (1 vs. 0 days; p 0.34), mortality rate (7.5 vs. 2.5%; p 0.41), and median length of hospital stay (9 days in both groups; p 0.46).

Conclusion

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

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Authors and Affiliations

  1. Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands

    Judith P. M. Schots, Misha D. P. Luyer & Grard A. P. Nieuwenhuijzen

Authors
  1. Judith P. M. Schots
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  2. Misha D. P. Luyer
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  3. Grard A. P. Nieuwenhuijzen
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Contributions

All authors have made substantial contributions to the conception and design of the study and acquisition, analysis, and interpretation of the data. All authors reviewed the manuscript critically for important intellectual content and approved submission of the final version of the manuscript.

Corresponding author

Correspondence to Judith P. M. Schots.

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Institutional Review Board

All data obtained were anonymous and in retrospect, in accordance with the “Code of Conduct for Health Research” by the Dutch Federation of Biomedical Scientific Societies (www.federa.org/codes-conduct). Therefore, review by an institutional review board was not necessary.

Informed Consent Statement

Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent. This is in accordance with the “Code of Conduct for Health Research” by the Dutch Federation of Biomedical Scientific Societies (www.federa.org/codes-conduct).

Conflict of Interest

The authors declare that they have no conflict of interest.

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Schots, J.P.M., Luyer, M.D.P. & Nieuwenhuijzen, G.A.P. Abdominal Drainage and Amylase Measurement for Detection of Leakage After Gastrectomy for Gastric Cancer. J Gastrointest Surg 22, 1163–1170 (2018). https://doi.org/10.1007/s11605-018-3789-7

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  • DOI: https://doi.org/10.1007/s11605-018-3789-7

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