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Purpose <p>Postoperative pancreatic fistula (POPF) is a severe complication of radical gastrectomy. Postoperative drain amylase levels (D-AMY) are correlated with POPF, but it’s not for prevention. The aim of this study is to investigate whether intraoperative amylase levels (I-AMY) of intra-abdominal exudates is associated with increased D-AMY.</p> Methods <p>From April 2021 to September 2023, 112 consecutive GC patients underwent radical gastrectomy with lymphadenectomy were enrolled. We measured the I-AMY of fluid from the left upper abdominal cavity (Area A), caudate fossa at the right upper abdominal cavity (Area B), and Area B after lavage with 20 mL of saline (Lavage Area B). We analyzed the correlation of I-AMY and D-AMY on POD1 and POD3. In the most recent 39 patients, we tested the effectiveness of polyglycolic acid (PGA) sheets around the pancreas after lymphadenectomy to prevent POPF.</p> Results <p>In 73 patients without PGA sheets, I-AMY in Area B and Lavage Area B were significantly correlated with D-AMY on POD1 and POD3 (Area B: POD1, Pearson’s <i>r</i> = 0.737, <i>p</i> &lt; 0.001; POD3, <i>r</i> = 0.457, <i>p</i> &lt; 0.001; Lavage Area B: POD1, <i>r</i> = 0.652, <i>p</i> &lt; 0.001; POD3, <i>r</i> = 0.353, <i>p</i> = 0.0022). Based on a receiver operating characteristic curve analysis, the cutoff value of I-AMY for predicting Biochemical leak (BL) or POPF was 1197 U/L in Area B (sensitivity: 50%, specificity: 88%) and 32 U/L in Lavage Area B (sensitivity: 81%, specificity: 52%). Unexpectedly, PGA sheets did not reduce D-AMY levels.</p> Conclusion <p>Intraoperative I-AMY measurement of exudates or lavage fluids in the caudate fossa may be useful for predicting BL or POPF after radical gastrectomy.</p>

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Clinical significance of intraoperative amylase levels on intra-abdominal exudates in the prediction of postoperative drain amylase levels after gastric cancer surgery

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  • 发表日期：

    2026年1月12日

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  • Yasuhiro Tsuru,
  • Hirokazu Noshiro,
  • Tomokazu Tanaka,
  • Yukie Yoda

摘要

Purpose

Postoperative pancreatic fistula (POPF) is a severe complication of radical gastrectomy. Postoperative drain amylase levels (D-AMY) are correlated with POPF, but it’s not for prevention. The aim of this study is to investigate whether intraoperative amylase levels (I-AMY) of intra-abdominal exudates is associated with increased D-AMY.

Methods

From April 2021 to September 2023, 112 consecutive GC patients underwent radical gastrectomy with lymphadenectomy were enrolled. We measured the I-AMY of fluid from the left upper abdominal cavity (Area A), caudate fossa at the right upper abdominal cavity (Area B), and Area B after lavage with 20 mL of saline (Lavage Area B). We analyzed the correlation of I-AMY and D-AMY on POD1 and POD3. In the most recent 39 patients, we tested the effectiveness of polyglycolic acid (PGA) sheets around the pancreas after lymphadenectomy to prevent POPF.

Results

In 73 patients without PGA sheets, I-AMY in Area B and Lavage Area B were significantly correlated with D-AMY on POD1 and POD3 (Area B: POD1, Pearson’s r = 0.737, p < 0.001; POD3, r = 0.457, p < 0.001; Lavage Area B: POD1, r = 0.652, p < 0.001; POD3, r = 0.353, p = 0.0022). Based on a receiver operating characteristic curve analysis, the cutoff value of I-AMY for predicting Biochemical leak (BL) or POPF was 1197 U/L in Area B (sensitivity: 50%, specificity: 88%) and 32 U/L in Lavage Area B (sensitivity: 81%, specificity: 52%). Unexpectedly, PGA sheets did not reduce D-AMY levels.

Conclusion

Intraoperative I-AMY measurement of exudates or lavage fluids in the caudate fossa may be useful for predicting BL or POPF after radical gastrectomy.