Optimal Timing to Assess Drain Amylase Concentration after Elective Gastrectomy

Area of Science:

• Gastroenterology and Surgical Oncology
• Biomarker Discovery and Validation
• Postoperative Complication Prediction

Background:

• Postoperative pancreas-related complications (PPRC) are a concern after gastrectomy.
• Drainage fluid amylase (dAmy) is a potential predictor of PPRC.
• Optimal timing for dAmy measurement requires further investigation.

Purpose of the Study:

• To determine the optimal timing for measuring drainage fluid amylase (dAmy) in predicting postoperative pancreas-related complications (PPRC) after gastrectomy.
• To evaluate the predictive value of dAmy and serum C-reactive protein (sCRP) at different postoperative time points.

Main Methods:

• Retrospective review of 387 patients undergoing elective gastrectomy.
• Comparison of dAmy and sCRP levels on postoperative days 1 and 3 between patients with and without PPRC.
• Analysis of optimal cutoff values and predictive accuracy using ROC curves and multivariate analysis.

Main Results:

• Drainage fluid amylase on postoperative day 1 (dAmy1) demonstrated higher predictive accuracy (AUC 0.915) than on day 3 (dAmy3, AUC 0.826).
• Serum C-reactive protein on postoperative day 3 (sCRP3) was a significant predictor (P=0.004), unlike sCRP on day 1 (sCRP1, P=0.831).
• A combination of high dAmy1 and high sCRP3 identified patients at high risk for severe PPRC (Clavien-Dindo ≥II).

Conclusions:

• dAmy measured on postoperative day 1 is more effective than on day 3 for predicting PPRC after gastrectomy.
• The combined assessment of dAmy1 and sCRP3 may provide a valuable criterion for safe drain removal on postoperative day 3.