ArticleLangenbeck's archives of surgery2026
Clinical significance of intraoperative amylase levels on intra-abdominal exudates in the prediction of postoperative drain amylase levels after gastric cancer surgery.
Article in Langenbeck's archives of surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposePostoperative 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.
methodsFrom 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.
resultsIn 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.
conclusionIntraoperative I-AMY measurement of exudates or lavage fluids in the caudate fossa may be useful for predicting BL or POPF after radical gastrectomy.
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