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Zhou M, Zhong G, Sun H, Zhu Q, Wang Z. Risk factors for postoperative pancreatic fistula (POPF) in gastric cancer patients: A systematic review and meta-analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:107092. [PMID: 37783104 DOI: 10.1016/j.ejso.2023.107092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/22/2023] [Accepted: 09/18/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND Postoperative pancreatic fistula (POPF) is a common and serious consequence of gastrectomy. The prevalence of POPF among patients with gastric cancer varies greatly, and the risk factors and outcomes of POPF are also controversial. The meta-analysis aims to comprehensively assess the risk factors for POPF in gastric cancer patients. METHODS PubMed, Web of Science, the Cochrane Library, Embase, and Chinese databases (SinoMed, CNKI, WanFang, and VIP Databases) were searched to identify relevant studies (from inception to May 2023). Two researchers evaluated the literature quality and extracted data individually. The Review Manager 5.4 program was used to analyze all of the data. RESULTS In our meta-analysis, 22 studies totaling 11,647 patients were analyzed. Male sex (OR = 3.06), older age (OR = 3.22), body mass index (BMI) ≥ 25 kg/m2 (OR = 2.58), visceral fat area (VFA) ≥ 100 cm2 (OR = 3.65), pTNM Ⅲ-Ⅳ (OR = 2.47), the number of lymphlode dissections (OR = 1.04), neoadjuvant chemotherapy (NAC) (OR = 2.91), the application of LigaSure (OR = 3.30), open surgery (OR = 3.23), intraoperative combined organ resection (OR = 4.11), drainage amylase concentration on the first postoperative day (OR = 5.73) and C-reactive protein on the 3rd postoperative day ≥20 mg/dL (OR = 7.29) were the risk factors for POPF in gastric cancer patients. On the other hand, the operation time (OR = 1.34) was not a risk factor for POPF. CONCLUSION The frequency of POPF in people undergoing gastrectomy was determined by a variety of risk factors. Medical professionals should identify risk factors early and impose interventions to prevent them to lower the incidence of POPF in gastric cancer patients.
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Affiliation(s)
- Ming Zhou
- Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Guangjun Zhong
- Baoying County People's Hospital, Yangzhou, Jiangsu Province, China
| | - Hui Sun
- Gaoyou City's People Hospital, Yangzhou, Jiangsu Province, China
| | - Qiaobo Zhu
- Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Zhengbing Wang
- Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu Province, China.
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2
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Wakahara T, Miura S, Yasuhara Y, Mukubo H, Kanemitsu K, Iwasaki T, Sasako M. Is the ISGPS definition of pancreatic fistula applicable after gastrectomy? Int J Clin Oncol 2022; 27:1273-1278. [DOI: 10.1007/s10147-022-02177-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/17/2022] [Indexed: 11/05/2022]
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3
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Pancreatic Fistula and Biochemical Leak after Splenectomy: Incidence and Risk Factors-A Retrospective Single-Center Analysis. Langenbecks Arch Surg 2022; 407:2517-2525. [PMID: 35508768 PMCID: PMC9468060 DOI: 10.1007/s00423-022-02531-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 04/21/2022] [Indexed: 11/24/2022]
Abstract
Purpose Postoperative pancreatic fistula (POPF) is a complication discussed in the context of pancreatic surgery, but may also result from splenectomy; a relationship that has not been investigated extensively yet. Methods This retrospective single-center study aimed to analyze incidence of and risk factors for POPF after splenectomy. Patient characteristics included demographic data, surgical procedure, and intra- and postoperative complications. POPF was defined according to the International Study Group on Pancreatic Surgery as POPF of grade B and C or biochemical leak (BL). Results Over ten years, 247 patients were identified, of whom 163 underwent primary (spleen-associated pathologies) and 84 secondary (extrasplenic oncological or technical reasons) splenectomy. Thirty-six patients (14.6%) developed POPF of grade B/C or BL, of which 13 occurred after primary (7.9%) and 23 after secondary splenectomy (27.3%). Of these, 25 (69.4%) were BL, 7 (19.4%) POPF of grade B and 4 (11.1%) POPF of grade C. BL were treated conservatively while three patients with POPF of grade B required interventional procedures and 4 with POPF of grade C required surgery. POPF and BL was noted significantly more often after secondary splenectomy and longer procedures. Multivariate analysis confirmed secondary splenectomy and use of energy-based devices as independent risk factors for development of POPF/BL after splenectomy. Conclusion With an incidence of 4.5%, POPF is a relevant complication after splenectomy. The main risk factor identified was secondary splenectomy. Although POPF and BL can usually be treated conservatively, it should be emphasized when obtaining patients’ informed consent and treated at centers with experience in pancreatic surgery. Supplementary Information The online version contains supplementary material available at 10.1007/s00423-022-02531-7.
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4
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Nakanishi K, Kanda M, Tanaka C, Takeda S, Tanaka K, Shimizu D, Inokawa Y, Hattori N, Hayashi M, Nakayama G, Fujiwara M, Kodera Y. Drain Amylase Concentrations at 3 h After Gastrectomy Enhance Early Prediction of Postoperative Peripancreatic Inflammatory Fluid Collection. World J Surg 2022; 46:648-655. [PMID: 34988602 DOI: 10.1007/s00268-021-06401-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Despite numerous studies of peripancreatic inflammatory fluid collection (PIFC) that report on the relevance of the drain amylase concentration (D-AMY), early prediction using this assay is problematic. This study aimed to investigate the clinical significance of measuring the D-AMY at 3 h after gastrectomy (POD0) for gastric cancer. METHODS This retrospective analysis included consecutive patients who underwent gastrectomy combined with peripancreatic lymph node dissection. The predictive value of D-AMY on POD0 and postoperative day 1 (POD1) for clinically relevant PIFC was evaluated together or individually. RESULTS Analyses were performed in 204 patients. Twenty (9.8%) patients experienced PIFC. D-AMY cutoffs of 721 IU/L on POD0 and 1695 IU/L on POD1 were determined using the receiver operating characteristic curve analysis for predicting PIFC. The D-AMY on POD0 had higher sensitivity (80%) but lower specificity (66.3%) for prediction of PIFC, compared with those of D-AMY on POD1 (65%, 89.1%, respectively). When combination marker analysis was performed, the highest risk group (D-AMY ≥ the cutoff values of POD0 and POD1) were associated with an elevated rate of occurrence (44%) and a high positive likelihood ratio (7.36) compared with those of the single cutoff group. The lowest risk group (D-AMY < the cutoff values on POD0 and POD1) was associated with a low rate of occurrence (2.5%) and low negative likelihood ratio (0.24) compared with those of the single cutoff group. CONCLUSIONS Combined measurements of D-AMYs on POD0 and POD1 enhanced early prediction of PIFC after gastrectomy.
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Affiliation(s)
- Koki Nakanishi
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan
| | - Mitsuro Kanda
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan.
| | - Chie Tanaka
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan
| | - Shigeomi Takeda
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan
| | - Katsuhito Tanaka
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan
| | - Dai Shimizu
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan
| | - Yoshikuni Inokawa
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan
| | - Norifumi Hattori
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan
| | - Masamichi Hayashi
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan
| | - Goro Nakayama
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan
| | - Michitaka Fujiwara
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan.,Department of Medical Equipment and Supplies Management, Nagoya University Hospital, Nagoya, Japan
| | - Yasuhiro Kodera
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan
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Martiniuc A, Dumitrascu T, Ionescu M, Tudor S, Lacatus M, Herlea V, Vasilescu C. Pancreatic Fistula after D1+/D2 Radical Gastrectomy according to the Updated International Study Group of Pancreatic Surgery Criteria: Risk Factors and Clinical Consequences. Experience of Surgeons with High Caseloads in a Single Surgical Center in Eastern Europe. J Gastric Cancer 2021; 21:16-29. [PMID: 33854810 PMCID: PMC8020004 DOI: 10.5230/jgc.2021.21.e3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 12/06/2020] [Accepted: 12/30/2020] [Indexed: 12/26/2022] Open
Abstract
Purpose Incidence, risk factors, and clinical consequences of pancreatic fistula (POPF) after D1+/D2 radical gastrectomy have not been well investigated in Western patients, particularly those from Eastern Europe. Materials and Methods A total of 358 D1+/D2 radical gastrectomies were performed by surgeons with high caseloads in a single surgical center from 2002 to 2017. A retrospective analysis of data that were prospectively gathered in an electronic database was performed. POPF was defined and graded according to the International Study Group for Pancreatic Surgery (ISGPS) criteria. Uni- and multivariate analyses were performed to identify potential predictors of POPF. Additionally, the impact of POPF on early complications and long-term outcomes were investigated. Results POPF was observed in 20 patients (5.6%), according to the updated ISGPS grading system. Cardiovascular comorbidities emerged as the single independent predictor of POPF formation (risk ratio, 3.051; 95% confidence interval, 1.161–8.019; P=0.024). POPF occurrence was associated with statistically significant increased rates of postoperative hemorrhage requiring re-laparotomy (P=0.029), anastomotic leak (P=0.002), 90-day mortality (P=0.036), and prolonged hospital stay (P<0.001). The long-term survival of patients with gastric adenocarcinoma was not affected by POPF (P=0.661). Conclusions In this large series of Eastern European patients, the clinically relevant rate of POPF after D1+/D2 radical gastrectomy was low. The presence of co-existing cardiovascular disease favored the occurrence of POPF and was associated with an increased risk of postoperative bleeding, anastomotic leak, 90-day mortality, and prolonged hospital stay. POPF was not found to affect the long-term survival of patients with gastric adenocarcinoma.
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Affiliation(s)
- Alexandru Martiniuc
- Department of General Surgery, Fundeni Clinical Institute, Bucharest, Romania.,Department of Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Traian Dumitrascu
- Department of General Surgery, Fundeni Clinical Institute, Bucharest, Romania.,Department of Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Mihnea Ionescu
- Department of General Surgery, Fundeni Clinical Institute, Bucharest, Romania
| | - Stefan Tudor
- Department of General Surgery, Fundeni Clinical Institute, Bucharest, Romania.,Department of Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Monica Lacatus
- Department of General Surgery, Fundeni Clinical Institute, Bucharest, Romania.,Department of Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Vlad Herlea
- Department of Pathology, Fundeni Clinical Institute, Bucharest, Romania.,Department of Pathology, Titu Maiorescu University, Bucharest, Romania
| | - Catalin Vasilescu
- Department of General Surgery, Fundeni Clinical Institute, Bucharest, Romania.,Department of Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Wakahara T, Kanemitsu K, Miura S, Tsuchida S, Iwasaki T, Sasako M. Optimal Timing to Assess Drain Amylase Concentration after Elective Gastrectomy. J Gastric Cancer 2021; 21:30-37. [PMID: 33854811 PMCID: PMC8020000 DOI: 10.5230/jgc.2021.21.e1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/26/2020] [Accepted: 01/16/2021] [Indexed: 12/26/2022] Open
Abstract
Purpose While the amylase concentration of the drainage fluid (dAmy) has been reported to be a predictor of postoperative pancreas-related complications (PPRC), the optimal timing for its measurement has not been fully investigated. Materials and Methods The clinicopathological data of 387 patients who underwent elective gastrectomy for gastric cancer were reviewed. Laboratory data, including dAmy on postoperative days 1 (dAmy1) and 3 (dAmy3), and serum C-reactive protein (sCRP) concentrations on postoperative days 1 (sCRP1) and 3 (sCRP3) were compared between patients with PPRC and without PPRC. Results Nineteen of the 387 patients (4.9%) developed PPRC. The optimal cutoff values of dAmy1, dAmy3, sCRP1, and sCRP3 were 1514 IU/L, 761 IU/L, 8.32 mg/dL, and 15.15 mg/dL, respectively. The area under the curve of dAmy1 was greater than that of dAmy3 (0.915 vs. 0.826), and that of sCRP3 was greater than that of sCRP1 (0.820 vs. 0.659). In the multivariate analysis, dAmy1 (P<0.001) and sCRP3 (P=0.004) were significant predictors of PPRC, while dAmy3 (P=0.069) and sCRP1 (P=0.831) were not. Thirteen (41.9%) of 31 patients with both dAmy1 ≥1,545 IU/L and sCRP3 ≥15.15 mg/dL had PPRC ≥Clavien-Dindo II. In contrast, among 260 patients with both dAmy1 <1,545 IU/L and sCRP3 <15.15 mg/dL, none developed PPRC. Conclusions dAmy1 was more useful than dAmy3 in predicting PPRC. The combination of dAmy1 and sCRP3 may be a useful criterion for the removal of drains on postoperative day 3.
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Affiliation(s)
| | | | - Susumu Miura
- Department of Surgery, Yodogawa Christian Hospital, Osaka, Japan
| | - Shinobu Tsuchida
- Department of Surgery, Yodogawa Christian Hospital, Osaka, Japan
| | - Takeshi Iwasaki
- Department of Surgery, Yodogawa Christian Hospital, Osaka, Japan
| | - Mitsuru Sasako
- Department of Surgery, Yodogawa Christian Hospital, Osaka, Japan
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7
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Washio M, Yamashita K, Niihara M, Hosoda K, Hiki N. Postoperative pancreatic fistula after gastrectomy for gastric cancer. Ann Gastroenterol Surg 2020; 4:618-627. [PMID: 33319151 PMCID: PMC7726690 DOI: 10.1002/ags3.12398] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/16/2020] [Accepted: 08/02/2020] [Indexed: 12/23/2022] Open
Abstract
Postoperative pancreatic fistula is one of the most severe complications after gastric cancer surgery, and can cause critical patient conditions leading to surgery-related death. Fortunately, the incidence of postoperative pancreatic fistula after gastrectomy seems to be decreasing with changes in operative procedures. The rate was reported at about 30% after open gastrectomy with Appleby's method in 1997, but lately has improved below 1% for robotic gastrectomy in 2019. For the diagnosis of postoperative pancreatic fistula, drain amylase concentration has been demonstrated to be beneficial and some reports have proposed the optimal cut-off values of drain amylase to predict major postoperative pancreatic fistula. There have been many reports identifying risk factors for postoperative pancreatic fistula, including overweight patients, pancreatic anatomy, blunt trauma from compression of the pancreas, and thermal injuries caused by the continuous use of energy devices. And importantly, laparoscopic gastrectomy has been shown to be more often associated with postoperative pancreatic fistula than open gastrectomy in the prospective national clinical database in Japan. Hence, further sophistication of surgical techniques to reduce pancreas compression would have great promise in reducing postoperative pancreatic fistula after laparoscopic gastrectomy.
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Affiliation(s)
- Marie Washio
- Department of Upper Gastrointestinal SurgeryKitasato University School of MedicineSagamiharaJapan
| | - Keishi Yamashita
- Department of Upper Gastrointestinal SurgeryKitasato University School of MedicineSagamiharaJapan
- Division of Advanced Surgical OncologyDepartment of Research and Development Center for New Medical FrontiersKitasato University School of MedicineSagamiharaJapan
| | - Masahiro Niihara
- Department of Upper Gastrointestinal SurgeryKitasato University School of MedicineSagamiharaJapan
| | - Kei Hosoda
- Department of Upper Gastrointestinal SurgeryKitasato University School of MedicineSagamiharaJapan
| | - Naoki Hiki
- Department of Upper Gastrointestinal SurgeryKitasato University School of MedicineSagamiharaJapan
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8
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Weindelmayer J, Mengardo V, Veltri A, Torroni L, Zhao E, Verlato G, de Manzoni G. Should we still use prophylactic drain in gastrectomy for cancer? A systematic review and meta-analysis. Eur J Surg Oncol 2020; 46:1396-1403. [PMID: 32457016 DOI: 10.1016/j.ejso.2020.05.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/28/2020] [Accepted: 05/09/2020] [Indexed: 01/23/2023] Open
Abstract
Prophylactic drain in gastrectomy for cancer is still widely used, although some evidence has disputed this practice and spreading enhanced recovery protocol has been pushing towards surgical simplification. This study aimed at assessing the impact of drain placement on important clinical outcomes, evaluating the results of randomised controlled trials (RCTs), or cohort studies whenever information provided by the former was scarce. PubMed, PMC, Cochrane Library, CNKI and Wanfang databases were searched from January 1990 to February 2019, both for RCTs and cohort studies comparing use or avoidance of prophylactic drain in gastric cancer patients undergoing gastrectomy. All RCTs and cohort studies were rated according to Jadad score and Newcastle-Ottawa-Scale, respectively. Meta-analysis was separately performed on RCTs and cohort studies. The following clinical outcomes were considered: anastomotic leak, reoperation rate, additional drain procedure, length of stay, postoperative morbidity, postoperative mortality, readmission rate and drain related complications. Overall, 3 RCTs (330 patients) and 7 cohort studies (2897 patients) were included. Seven studies came from Eastern Countries. Meta-analysis on RCTs evidenced that drain avoidance halves overall morbidity (RR = 0.47, 95%CI 0.26-0.86, p = 0.014) and slightly reduces length of stay (SMD -0.24, 95%CI -0.51-0.03, p = 0.083). Only one postoperative death occurred in the drain group. The other outcomes were either not reported or reported just by one RCT each. Meta-analysis on cohort studies, despite higher statistical power, did not highlight any significant difference. This meta-analysis showed that prophylactic drain avoidance can reduce morbidity and length of stay, while not significantly affecting other major surgical outcomes.
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Affiliation(s)
- Jacopo Weindelmayer
- Upper G.I. Surgery Division, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Valentina Mengardo
- Upper G.I. Surgery Division, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy.
| | - Alessandro Veltri
- Upper G.I. Surgery Division, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Lorena Torroni
- Department of Diagnostics and Public Health, University of Verona, Strada le Grazie, 8, 37134, Verona, Italy
| | - Enhao Zhao
- Department of General Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, 160 Pujian Road, 200127, Shanghai, China
| | - Giuseppe Verlato
- Department of Diagnostics and Public Health, University of Verona, Strada le Grazie, 8, 37134, Verona, Italy
| | - Giovanni de Manzoni
- Upper G.I. Surgery Division, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
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Nakanishi K, Kanda M, Sakamoto J, Kodera Y. Is the measurement of drain amylase content useful for predicting pancreas-related complications after gastrectomy with systematic lymphadenectomy? World J Gastroenterol 2020; 26:1594-1600. [PMID: 32327908 PMCID: PMC7167417 DOI: 10.3748/wjg.v26.i14.1594] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 01/13/2020] [Accepted: 03/22/2020] [Indexed: 02/06/2023] Open
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.
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Affiliation(s)
- Koki Nakanishi
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Mitsuro Kanda
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | | | - Yasuhiro Kodera
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
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10
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Wakahara T, Kanemitsu K, Asari S, Tsuchida S, Ueno N, Toyokawa A, Sasako M. The Combined Use of Drainage Amylase Concentration and Serum C-reactive Protein as Predictors of Pancreas-Related Complications after Elective Gastrectomy. Oncology 2019; 98:111-116. [PMID: 31600759 DOI: 10.1159/000503581] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 09/17/2019] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Postoperative pancreas-related complications (PPRC) can cause critical conditions, including sepsis and intra-abdominal bleeding. Thus, it is important to identify patients who are at risk of clinically significant PPRC as early as possible in the postoperative period. Some authors have reported the use of amylase concentration of the drainage fluid (dAmy) to predict PPRC. However, the positive predictive value of dAmy alone is not sufficient. OBJECTIVE The aim of this study is to evaluate the predictive value of combined use of dAmy and serum C-reactive protein (sCRP) for PPRC. METHODS The clinicopathological data of 327 patients who underwent elective gastrectomy for gastric cancer were reviewed. There were 18 patients who developed PPRC. Univariate and multivariate analyses were conducted to identify the risk factors of PPRC. Receiver operating characteristic curves were used to identify the cut-off values of dAmy and sCRP on postoperative day 3 (dAmy3 and sCRP3) to predict the risk of PPRC. RESULTS In the multivariate analysis, splenectomy alone correlated with PPRC. The cut-off values of dAmy3 and sCRP3 were 761 IU/L and 15.15 mg/dL, respectively. Among the 17 patients with both dAmy3 and sCRP3 above the thresholds, 10 (58.8%) had PPRC with Clavien-Dindo classification (CD) ≥II and 7 (41.2%) had PPRC with CD ≥III. In contrast, among the 236 patients with both parameters below the thresholds, 233 (98.7%) did not develop PPRC, and only 1 (0.4%) had PPRC with CD ≥III. CONCLUSIONS Splenectomy correlates with PPRC, which is consistent with results from large clinical trials. A combined use of dAmy3 and sCRP3 can be useful in predicting the risks of PPRC.
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Affiliation(s)
| | | | - Sadaki Asari
- Department of Surgery, Yodogawa Christian Hospital, Osaka, Japan
| | - Shinobu Tsuchida
- Department of Surgery, Yodogawa Christian Hospital, Osaka, Japan
| | - Nozomi Ueno
- Department of Surgery, Yodogawa Christian Hospital, Osaka, Japan
| | - Akihiro Toyokawa
- Department of Surgery, Yodogawa Christian Hospital, Osaka, Japan
| | - Mitsuru Sasako
- Department of Surgery, Yodogawa Christian Hospital, Osaka, Japan
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11
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HASBAHÇECİ M, CENGİZ MB, AKÇAKAYA A, MALYA FÜ, KUNDUZ E, BEKTAŞOĞLU HK. Impact of high amylase level in drainage fluid after gastric cancer surgery: Is it a complication or suspicious biochemical measurement? CUKUROVA MEDICAL JOURNAL 2019; 44:594-601. [DOI: 10.17826/cumj.450246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
Purpose: Pancreatic fistula is a
potential postoperative complication with variable definitions, incidences and
risk factors. We intended to evaluate its impact after gastric surgery. Materials and Methods: A total of 28 consecutive patients
who underwent curative open gastrectomy with lymphadenectomy for gastric
adenocarcinoma were retrospectively analyzed. Patients’ demographics,
peri-operative and pathological data were collected. Pancreatic fistula that
was diagnosed and graded according to International Study Group of Pancreatic
Fistula’s system was identified as main variable.Results: Mean age of
patients was 58.8±10.1 years with a female to male ratio of 9/19. Grade
A pancreatic fistula was diagnosed in six patients (21.4%). There was no grade B and C pancreatic
fistula. Drain amylase level was significantly higher in patients with
pancreatic fistula (p=0.0001). There was no significant difference with regard
to amount of drainage, length of hospital stay and duration of drains in
patients with and without fistula. No significant association was shown between
development of fistula and patients’ demographics, peri-operative and
pathological data.
Conclusion: The development of grade A
pancreatic fistula after gastric surgery does not appear to be a major
complication with clinical consequences. High amylase level in the drainage
fluid can be considered as a biochemical measure only.
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Affiliation(s)
| | | | - Adem AKÇAKAYA
- bezmialem vakıf üniversitesi tıp fakültesi genel cerrahi AD
| | | | - Enver KUNDUZ
- bezmialem vakıf üniversitesi tıp fakültesi genel cerrahi AD
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Yamagata Y, Yoshikawa T, Yura M, Otsuki S, Morita S, Katai H, Nishida T. Current status of the "enhanced recovery after surgery" program in gastric cancer surgery. Ann Gastroenterol Surg 2019; 3:231-238. [PMID: 31131351 PMCID: PMC6524106 DOI: 10.1002/ags3.12232] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 12/18/2018] [Accepted: 12/20/2018] [Indexed: 12/11/2022] Open
Abstract
Since the late 1990s, perioperative care through the enhanced recovery after surgery (ERAS, European Society for Clinical Nutrition and Metabolism [ESPEN]) program has spread. ERAS protocols aim to reduce surgical complications, improving postoperative outcomes and thereby saving resources by addressing various clinical elements through a multidisciplinary approach or based on evidence. In the field of gastric cancer, the philosophy of ERAS has gradually become accepted and, in 2014, consensus guidelines for enhanced recovery after gastrectomy were published. These guidelines consist of "procedure-specific" guidelines and "general (not procedure-specific) enhanced recovery items." In this review, we focused on the procedure-specific guidelines and tried to update the contents of every element of the procedure-specific guidelines. The procedure-specific guidelines consist of the following eight elements: "Preoperative nutrition," "Preoperative oral pharmaconutrition," "Access (of gastrectomy)," "Wound catheters and transversus abdominis plane block," "Nasogastric/Nasojejunal decompression," "Perianastomotic drains," "Early postoperative diet and artificial nutrition," and "Audit." On reviewing papers supporting these elements, it was reconfirmed that the recommendations of the guidelines are pertinent and valid. Four meta-analyses concerning the evaluation of ERAS protocols for gastric cancer were included in this review. Every study showed that the ERAS protocol reduced the cost and duration of hospital stay without increasing surgical complication rates, suggesting that ERAS is effective for gastric cancer surgery. However, it cannot be said that ERAS has achieved full penetration in Japan because most evidence is established in Western countries. Future studies must focus on developing a new ERAS protocols appropriate to Japanese conditions of gastric cancer.
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Affiliation(s)
- Yukinori Yamagata
- Department of Gastric SurgeryNational Cancer Center HospitalTokyoJapan
| | - Takaki Yoshikawa
- Department of Gastric SurgeryNational Cancer Center HospitalTokyoJapan
| | - Masahiro Yura
- Department of Gastric SurgeryNational Cancer Center HospitalTokyoJapan
| | - Sho Otsuki
- Department of Gastric SurgeryNational Cancer Center HospitalTokyoJapan
| | - Shinji Morita
- Department of Gastric SurgeryNational Cancer Center HospitalTokyoJapan
| | - Hitoshi Katai
- Department of Gastric SurgeryNational Cancer Center HospitalTokyoJapan
| | - Toshiro Nishida
- Department of Gastric SurgeryNational Cancer Center HospitalTokyoJapan
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Abdominal Drainage and Amylase Measurement for Detection of Leakage After Gastrectomy for Gastric Cancer. J Gastrointest Surg 2018; 22:1163-1170. [PMID: 29736661 DOI: 10.1007/s11605-018-3789-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 04/16/2018] [Indexed: 01/31/2023]
Abstract
PURPOSE To investigate the value of daily measurement of drain amylase for detecting leakage in gastric cancer surgery. METHODS This was a retrospective analysis including all patients who underwent a gastrectomy for gastric cancer. From January 2013 until December 2015, an intra-abdominal drain was routinely placed. Drain amylase was measured daily. Receiver operator characteristic curves were created to assess the ability of amylase to predict leakage. Sensitivity, specificity, and negative and positive predictive value of amylase in drain fluid were determined. Leakage of the gastrojejunostomy or esophagojejunostomy, enteroenterostomy, duodenal stump, or pancreas was diagnosed by CT scan, endoscopy, or during re-operation. From January 2016 until April 2017, no drain was inserted. Surgical outcome and postoperative complications were compared between both groups. RESULTS Median drain amylase concentrations were higher for each postoperative day in patients with leakage. The optimal cutoff value was 1000 IU/L (sensitivity 77.8%, specificity 98.2%, negative predictive value 96.6%). Sixty-seven consecutive procedures were performed with a drain and 40 procedures without. No differences in group characteristics were observed except for gender. Fourteen patients (13.1%) had a leakage. The incidence and severity of leakage were not different between the patients with and without a drain. There was no significant difference in time to diagnosis (1 vs. 0 days; p 0.34), mortality rate (7.5 vs. 2.5%; p 0.41), and median length of hospital stay (9 days in both groups; p 0.46). CONCLUSION Daily amylase measurement in drain fluid does not influence the early recognition and management of leakage in gastric cancer surgery.
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