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Predictive value of drain amylase content for peripancreatic inflammatory fluid collections after laparoscopic (assisted) distal gastrectomy

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Abstract

Background

Laparoscopic (assisted) distal gastrectomy (LDG) with radical lymphadenectomy for gastric cancer has been widely conducted, particularly in the Far East. Peripancreatic inflammatory fluid collection (PIFC) is a serious and frequent postoperative complication after LDG for gastric cancer. The aim of this study was to evaluate the diagnostic performance of drain amylase content (D-AMY) for clinically relevant PIFC after LDG.

Methods

Two hundred and sixty-four patients who underwent LDG with prophylactic drains were enrolled. The predictive value of D-AMY on postoperative day (POD) 1 and POD 3 in the diagnosis of PIFC was evaluated.

Results

Twenty (7.6 %) patients experienced postoperative PIFC. Area under the curve in terms of receiver operating characteristics curve analysis of D-AMY on POD 1 was 0.801, and the optimal cutoff value for prediction of PIFC was 904 IU/l, with 98.2 % negative predictive value. Another cutoff was proposed as 4078 IU/l, with 92.2 % specificity. Multivariable analyses identified D-AMY on POD 1 ≥900 and ≥4000 IU/l as independent diagnostic factors for PIFC. Among patients at high risk of PIFC (D-AMY on POD 1 ≥900 IU/l), those who on POD 3 retained D-AMY value in excess of 31.2 % of the D-AMY value on POD 1 were more likely to experience PIFC compared with those with a pronounced decrease in D-AMY.

Conclusions

D-AMY on POD 1 serves as a predictive factor for clinically relevant PIFC after LDG. Time-dependent changes in D-AMY can also be used for determining management of drains in patients at high risk of PIFC.

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References

  1. Siegel R, Naishadham D, Jemal A (2012) Cancer statistics, 2012. CA Cancer J Clin 62:10–29

    Article  PubMed  Google Scholar 

  2. Leung WK, Wu MS, Kakugawa Y, Kim JJ, Yeoh KG, Goh KL, Wu KC, Wu DC, Sollano J, Kachintorn U, Gotoda T, Lin JT, You WC, Ng EK, Sung JJ (2008) Screening for gastric cancer in Asia: current evidence and practice. Lancet Oncol 9:279–287

    Article  PubMed  Google Scholar 

  3. Kanda M, Kobayashi D, Tanaka C, Iwata N, Yamada S, Fujii T, Nakayama G, Sugimoto H, Koike M, Nomoto S, Murotani K, Fujiwara M, Kodera Y (2016) Adverse prognostic impact of perioperative allogeneic transfusion on patients with stage II/III gastric cancer. Gastric Cancer 19:255–263

    Article  CAS  PubMed  Google Scholar 

  4. Shen L, Shan YS, Hu HM, Price TJ, Sirohi B, Yeh KH, Yang YH, Sano T, Yang HK, Zhang X, Park SR, Fujii M, Kang YK, Chen LT (2013) Management of gastric cancer in Asia: resource-stratified guidelines. Lancet Oncol 14:e535–e547

    Article  PubMed  Google Scholar 

  5. Hartgrink HH, Jansen EP, van Grieken NC, van de Velde CJ (2009) Gastric cancer. Lancet 374:477–490

    Article  PubMed  PubMed Central  Google Scholar 

  6. Japanese Gastric Cancer Association (2011) Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer 14:113–123

    Article  Google Scholar 

  7. Songun I, Putter H, Kranenbarg EM, Sasako M, van de Velde CJ (2010) Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol 11:439–449

    Article  PubMed  Google Scholar 

  8. Katai H, Sasako M, Fukuda H, Nakamura K, Hiki N, Saka M, Yamaue H, Yoshikawa T, Kojima K (2010) Safety and feasibility of laparoscopy-assisted distal gastrectomy with suprapancreatic nodal dissection for clinical stage I gastric cancer: a multicenter phase II trial (JCOG 0703). Gastric Cancer 13:238–244

    Article  PubMed  Google Scholar 

  9. Kim HH, Hyung WJ, Cho GS, Kim MC, Han SU, Kim W, Ryu SW, Lee HJ, Song KY (2010) Morbidity and mortality of laparoscopic gastrectomy versus open gastrectomy for gastric cancer: an interim report—a phase III multicenter, prospective, randomized trial (KLASS trial). Ann Surg 251:417–420

    Article  PubMed  Google Scholar 

  10. Kim HH, Han SU, Kim MC, Hyung WJ, Kim W, Lee HJ, Ryu SW, Cho GS, Song KY, Ryu SY (2014) Long-term results of laparoscopic gastrectomy for gastric cancer: a large-scale case–control and case-matched Korean multicenter study. J Clin Oncol 32:627–633

    Article  PubMed  Google Scholar 

  11. Obama K, Okabe H, Hosogi H, Tanaka E, Itami A, Sakai Y (2011) Feasibility of laparoscopic gastrectomy with radical lymph node dissection for gastric cancer: from a viewpoint of pancreas-related complications. Surgery 149:15–21

    Article  PubMed  Google Scholar 

  12. Jiang X, Hiki N, Nunobe S, Kumagai K, Nohara K, Sano T, Yamaguchi T (2012) Postoperative pancreatic fistula and the risk factors of laparoscopy-assisted distal gastrectomy for early gastric cancer. Ann Surg Oncol 19:115–121

    Article  PubMed  Google Scholar 

  13. Hiura Y, Takiguchi S, Yamamoto K, Kurokawa Y, Yamasaki M, Nakajima K, Miyata H, Fujiwara Y, Mori M, Doki Y (2013) Use of fibrin glue sealant with polyglycolic acid sheets to prevent pancreatic fistula formation after laparoscopic-assisted gastrectomy. Surg Today 43:527–533

    Article  CAS  PubMed  Google Scholar 

  14. Kunisaki C, Makino H, Takagawa R, Sato K, Kawamata M, Kanazawa A, Yamamoto N, Nagano Y, Fujii S, Ono HA, Akiyama H, Shimada H (2009) Predictive factors for surgical complications of laparoscopy-assisted distal gastrectomy for gastric cancer. Surg Endosc 23:2085–2093

    Article  PubMed  Google Scholar 

  15. Iwata N, Kodera Y, Eguchi T, Ohashi N, Nakayama G, Koike M, Fujiwara M, Nakao A (2010) Amylase concentration of the drainage fluid as a risk factor for intra-abdominal abscess following gastrectomy for gastric cancer. World J Surg 34:1534–1539

    Article  PubMed  Google Scholar 

  16. Lo CH, Chen JH, Wu CW, Lo SS, Hsieh MC, Lui WY (2008) Risk factors and management of intra-abdominal infection after extended radical gastrectomy. Am J Surg 196:741–745

    Article  PubMed  Google Scholar 

  17. Wang Z, Chen J, Su K, Dong Z (2011) Abdominal drainage versus no drainage post gastrectomy for gastric cancer. Cochrane Database Syst Rev 5:CD008788

    Google Scholar 

  18. Yu HW, Jung DH, Son SY, Lee CM, Lee JH, Ahn SH, Park DJ, Kim HH (2013) Risk factors of postoperative pancreatic fistula in curative gastric cancer surgery. J Gastric Cancer 13:179–184

    Article  PubMed  PubMed Central  Google Scholar 

  19. Inaki N, Etoh T, Ohyama T, Uchiyama K, Katada N, Koeda K, Yoshida K, Takagane A, Kojima K, Sakuramoto S, Shiraishi N, Kitano S (2015) A multi-institutional, prospective, phase II feasibility study of laparoscopy-assisted distal gastrectomy with D2 lymph node dissection for locally advanced gastric cancer (JLSSG0901). World J Surg 39:2734–2741

    Article  PubMed  Google Scholar 

  20. Kanda M, Fujii T, Suenaga M, Takami H, Hattori M, Inokawa Y, Yamada S, Nakayama G, Sugimoto H, Koike M, Nomoto S, Kodera Y (2014) Estimated pancreatic parenchymal remnant volume accurately predicts clinically relevant pancreatic fistula after pancreatoduodenectomy. Surgery 156:601–610

    Article  PubMed  Google Scholar 

  21. Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13

    Article  PubMed  Google Scholar 

  22. Kanda M, Fujii T, Takami H, Suenaga M, Inokawa Y, Yamada S, Kobayashi D, Tanaka C, Sugimoto H, Koike M, Nomoto S, Fujiwara M, Kodera Y (2014) Novel diagnostics for aggravating pancreatic fistulas at the acute phase after pancreatectomy. World J Gastroenterol 20:8535–8544

    Article  PubMed  PubMed Central  Google Scholar 

  23. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibanes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196

    Article  PubMed  Google Scholar 

  24. Fujii T, Kanda M, Nagai S, Suenaga M, Takami H, Yamada S, Sugimoto H, Nomoto S, Nakao A, Kodera Y (2015) Excess weight adversely influences treatment length of postoperative pancreatic fistula: a retrospective study of 900 patients. Pancreas 44:971–976

    Article  PubMed  Google Scholar 

  25. Kanda M, Fujii T, Kodera Y, Nagai S, Takeda S, Nakao A (2011) Nutritional predictors of postoperative outcome in pancreatic cancer. Br J Surg 98:268–274

    Article  CAS  PubMed  Google Scholar 

  26. Fujii T, Nakao A, Murotani K, Okamura Y, Ishigure K, Hatsuno T, Sakai M, Yamada S, Kanda M, Sugimoto H, Nomoto S, Takeda S, Morita S, Kodera Y (2015) Influence of food intake on the healing process of postoperative pancreatic fistula after pancreatoduodenectomy: a multi-institutional randomized controlled trial. Ann Surg Oncol 22:3905–3912

    Article  PubMed  Google Scholar 

  27. Kanda M, Murotani K, Kobayashi D, Tanaka C, Yamada S, Fujii T, Nakayama G, Sugimoto H, Koike M, Fujiwara M, Kodera Y (2015) Postoperative adjuvant chemotherapy with S-1 alters recurrence patterns and prognostic factors among patients with stage II/III gastric cancer: a propensity score matching analysis. Surgery 158:1573–1580

    Article  PubMed  Google Scholar 

  28. Kitano S, Iso Y, Moriyama M, Sugimachi K (1994) Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc 4:146–148

    CAS  PubMed  Google Scholar 

  29. Lee J, Jeon H (2014) The clinical indication and feasibility of the enhanced recovery protocol for curative gastric cancer surgery: analysis of 147 consecutive experiences. Dig Surg 31:318–323

    Article  PubMed  Google Scholar 

  30. Pedziwiatr M, Matlok M, Kisialeuski M, Migaczewski M, Major P, Winiarski M, Budzynski P, Zub-Pokrowiecka A, Budzynski A (2014) Short hospital stays after laparoscopic gastric surgery under an Enhanced Recovery After Surgery (ERAS) pathway: experience at a single center. Eur Surg 46:128–132

    Article  PubMed  PubMed Central  Google Scholar 

  31. Liu HP, Zhang YC, Zhang YL, Yin LN, Wang J (2011) Drain versus no-drain after gastrectomy for patients with advanced gastric cancer: systematic review and meta-analysis. Dig Surg 28:178–189

    Article  PubMed  Google Scholar 

  32. Ojima T, Iwahashi M, Nakamori M, Nakamura M, Naka T, Ishida K, Ueda K, Katsuda M, Iida T, Tsuji T, Yamaue H (2009) Influence of overweight on patients with gastric cancer after undergoing curative gastrectomy: an analysis of 689 consecutive cases managed by a single center. Arch Surg 144:351–358 (discussion 358)

    Article  PubMed  Google Scholar 

  33. Fujii T, Sugimoto H, Yamada S, Kanda M, Suenaga M, Takami H, Hattori M, Inokawa Y, Nomoto S, Fujiwara M, Kodera Y (2014) Modified Blumgart anastomosis for pancreaticojejunostomy: technical improvement in matched historical control study. J Gastrointest Surg 18:1108–1115

    Article  PubMed  Google Scholar 

  34. Kanda M, Fujii T, Suenaga M, Takami H, Inokawa Y, Yamada S, Kobayashi D, Tanaka C, Sugimoto H, Nomoto S, Fujiwara M, Kodera Y (2014) Pancreatoduodenectomy with portal vein resection is feasible and potentially beneficial for elderly patients with pancreatic cancer. Pancreas 43:951–958

    Article  PubMed  Google Scholar 

  35. Bo T, Zhihong P, Peiwu Y, Feng Q, Ziqiang W, Yan S, Yongliang Z, Huaxin L (2009) General complications following laparoscopic-assisted gastrectomy and analysis of techniques to manage them. Surg Endosc 23:1860–1865

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan

    Mitsuro Kanda, Michitaka Fujiwara, Chie Tanaka, Daisuke Kobayashi, Naoki Iwata, Akira Mizuno, Suguru Yamada, Tsutomu Fujii, Goro Nakayama, Hiroyuki Sugimoto, Masahiko Koike & Yasuhiro Kodera

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  1. Mitsuro Kanda
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  2. Michitaka Fujiwara
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Correspondence to Michitaka Fujiwara.

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Mitsuro Kanda, Michitaka Fujiwara, Chie Tanaka, Daisuke Kobayashi, Naoki Iwata, Akira Mizuno, Suguru Yamada, Tsutomu Fujii, Goro Nakayama, Hiroyuki Sugimoto, Masahiko Koike, and Yasuhiro Kodera have no conflicts of interest or financial ties to disclose.

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Kanda, M., Fujiwara, M., Tanaka, C. et al. Predictive value of drain amylase content for peripancreatic inflammatory fluid collections after laparoscopic (assisted) distal gastrectomy. Surg Endosc 30, 4353–4362 (2016). https://doi.org/10.1007/s00464-016-4753-9

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