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. 2021 Mar;21(1):30-37.
doi: 10.5230/jgc.2021.21.e1. Epub 2021 Mar 2.

Optimal Timing to Assess Drain Amylase Concentration after Elective Gastrectomy

Tomoyuki Wakahara  1 , Kiyonori Kanemitsu  1 , Susumu Miura  1 , Shinobu Tsuchida  1 , Takeshi Iwasaki  1 , Mitsuru Sasako  1
Affiliations

Optimal Timing to Assess Drain Amylase Concentration after Elective Gastrectomy

Tomoyuki Wakahara et al. J Gastric Cancer. 2021 Mar.

Abstract

Purpose: While the amylase concentration of the drainage fluid (dAmy) has been reported to be a predictor of postoperative pancreas-related complications (PPRC), the optimal timing for its measurement has not been fully investigated.

Materials and methods: The clinicopathological data of 387 patients who underwent elective gastrectomy for gastric cancer were reviewed. Laboratory data, including dAmy on postoperative days 1 (dAmy1) and 3 (dAmy3), and serum C-reactive protein (sCRP) concentrations on postoperative days 1 (sCRP1) and 3 (sCRP3) were compared between patients with PPRC and without PPRC.

Results: Nineteen of the 387 patients (4.9%) developed PPRC. The optimal cutoff values of dAmy1, dAmy3, sCRP1, and sCRP3 were 1514 IU/L, 761 IU/L, 8.32 mg/dL, and 15.15 mg/dL, respectively. The area under the curve of dAmy1 was greater than that of dAmy3 (0.915 vs. 0.826), and that of sCRP3 was greater than that of sCRP1 (0.820 vs. 0.659). In the multivariate analysis, dAmy1 (P<0.001) and sCRP3 (P=0.004) were significant predictors of PPRC, while dAmy3 (P=0.069) and sCRP1 (P=0.831) were not. Thirteen (41.9%) of 31 patients with both dAmy1 ≥1,545 IU/L and sCRP3 ≥15.15 mg/dL had PPRC ≥Clavien-Dindo II. In contrast, among 260 patients with both dAmy1 <1,545 IU/L and sCRP3 <15.15 mg/dL, none developed PPRC.

Conclusions: dAmy1 was more useful than dAmy3 in predicting PPRC. The combination of dAmy1 and sCRP3 may be a useful criterion for the removal of drains on postoperative day 3.

Keywords: Amylases; C-reactive protein; Gastrectomy; Pancreatic fistula; Predictor.

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Conflict of interest statement

Conflict of Interest: No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1. Receiver operating characteristic curves of the amylase (A, B) and serum C-reactive protein (C, D) concentrations in the drainage fluid on postoperative days 1 and day 3, respectively, for predicting postoperative pancreas-related complications. The arrow indicates the optimal cutoff point. The optimal cutoff values and areas under the curve are (A) 1,514 and 0.915 IU/L, (B) 761 and 0.826 IU/L, (C) 8.32 and 0.659 mg/dL, and (D) 15.15 and 0.820 mg/dL, respectively.
Fig. 2
Fig. 2. Correlations between dAmy1 and dAmy3. The correlation coefficient was 0.786. dAmy3 was −731.059+1.017 dAmy1.
dAmy1 = amylase concentration of the drainage fluid on postoperative day 1; dAmy3 = amylase concentration of the drainage fluid on postoperative day 3.
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