Drain Amylase Concentrations at 3h After Gastrectomy Enhance Early Prediction of Postoperative Peripancreatic Inflammatory Fluid Collection
Drain Amylase Concentrations at 3h After Gastrectomy Enhance Early Prediction of Postoperative Peripancreatic Inflammatory Fluid Collection
复制标题
胃切除术后 3 小时排出淀粉酶浓度可增强术后胰周炎症液体收集的早期预测
DOI：
10.1007/s00268-021-06401-z
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发表时间：
2022
影响因子：
2.6
通讯作者：
Yasuhiro Kodera
中科院分区：
文献类型：
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作者：
Koki Nakanishi;Mitsuro Kanda;Chie Tanaka;Shigeomi Takeda;Katsuhito Tanaka;Dai Shimizu;Yoshikuni Inokawa;Norifumi Hattori;Masamichi Hayashi;Goro Nakayama;Michitaka Fujiwara;Yasuhiro Kodera
背景尽管有许多关于胰周炎性液体收集（PIFC）的研究报道了引流淀粉酶浓度（D-AMY）的相关性，但使用该测定进行早期预测是有问题的。本研究旨在探讨测量D-AMY在3小时后胃切除术（POD 0）胃癌的临床意义。MethodsThis回顾性分析包括连续患者进行胃切除术联合胰周淋巴结清扫术。D-AMY对POD 0和术后第1天（POD 1）临床相关PIFC的预测价值进行了评估，共同或单独。20例（9.8%）患者发生PIFC。使用预测PIFC的受试者工作特征曲线分析，确定POD 0的D-AMY临界值为721 IU/L，POD 1的D-AMY临界值为1695 IU/L。与POD 1的D-AMY（分别为65%和89.1%）相比，POD 0的D-AMY预测PIFC的敏感性（80%）较高，但特异性（66.3%）较低。当进行组合标志物分析时，与单一临界值组相比，最高风险组（D-AMY ≥ POD 0和POD 1的临界值）的发生率（44%）和阳性似然比（7.36）较高。最低风险组（D-AMY <POD 0和POD 1的临界值）与较低的发生率（2.5%）和较低的阴性似然比（0.24）相关联，与单一临界组相比。
BackgroundDespite 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.MethodsThis 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.ResultsAnalyses 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.ConclusionsCombined measurements of D‐AMYs on POD0 and POD1 enhanced early prediction of PIFC after gastrectomy.