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World J Gastroenterol. Apr 14, 2020; 26(14): 1594-1600
Published online Apr 14, 2020. doi: 10.3748/wjg.v26.i14.1594
Is the measurement of drain amylase content useful for predicting pancreas-related complications after gastrectomy with systematic lymphadenectomy?
Koki Nakanishi, Mitsuro Kanda, Junichi Sakamoto, Yasuhiro Kodera
Koki Nakanishi, Mitsuro Kanda, Yasuhiro Kodera, Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
Junichi Sakamoto, Tokai Central Hospital, Kakamigahara 504-8601, Japan
Author contributions: Nakanishi K wrote the paper; Nakanishi K, Kanda M, Sakamoto J, and Kodera Y critically revised the article.
Conflict-of-interest statement: No potential conflicts of interest. No financial support.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Mitsuro Kanda, FACS, MD, PhD, Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan. m-kanda@med.nagoya-u.ac.jp
Received: December 24, 2019
Peer-review started: December 24, 2019
First decision: January 12, 2020
Revised: January 13, 2020
Accepted: March 22, 2020
Article in press: March 22, 2020
Published online: April 14, 2020
Processing time: 111 Days and 22.7 Hours
Abstract

Many studies investigating postoperative pancreatic fistula (POPF) after gastrectomy, including studies measuring drain amylase content (D-AMY) as a predictive factor have been reported. This article reviews previous studies and looks to the future of measuring D-AMY in patients after gastrectomy. The causes of pancreatic fluid leakage are; the parenchymal and/or thermal injury to the pancreas, and blunt injury to the pancreas by compression and retraction. Measurement of D-AMY to predict POPF has become common in clinical practice after pancreatic surgery and was later extended to the gastric surgery. Several studies have reported associations between D-AMY and POPF after gastrectomy, and the high value of D-AMY on postoperative day (POD) 1 was an independent risk factor. To improve both sensitivity and specificity, attempts have been made to enhance the predictive accuracy of factors on POD 1 as well as on POD 3 as combined markers. Although several studies have shown a high predictive ability of POPF, it has not necessarily been exploited in clinical practice. Many problems remain unresolved; ideal timing for measurement, optimal cut-off value, and means of intervention after prediction. Prospective clinical trial could be imperative in order to develop D-AMY measurement in common clinical practice for gastric surgery.

Keywords: Gastric cancer; Drain amylase; Postoperative pancreatic fistula; Pancreas-related complications; Gastrectomy; Early prediction

Core tip: Many studies investigating postoperative pancreatic fistula after gastrectomy, including measurement of drain amylase content (D-AMY) as a predictive factor. This article reviews previous studies and looks to the future of measuring D-AMY in patients after gastrectomy. Several studies have reported that the high D-AMY on postoperative day 1 or day 3 was an independent risk factor for postoperative pancreatic fistula. However, issues for clinical use remain unresolved, including the ideal timing of measurement, optimal cut-off value and intervention after prediction. Prospective clinical trials might be indispensable for D-AMY to become a common marker in clinical practice.