title: Is routine measurement of amylase concentration in drainage fluid necessary after total gastrectomy for gastric cancer?
abstract: OBJECTIVE
  Measurement of amylase level in drainage fluid (D-AMY) is often performed for detection of pancreatic fistula (PF) formation after total gastrectomy. However, PF incidence has decreased and PF formation can be judged by changes in drainage fluid properties. The aim of study is to compare the significance of drainage fluid inspection for PF formation with D-AMY measurement.
  
  
  METHODS
  PF incidence, drainage fluid properties, and D-AMY level in drainage fluid were investigated retrospectively in 173 patients undergoing total gastrectomy for gastric cancer. The sensitivity and specificity of changes in fluid properties for PF detection were compared to D-AMY measurement.
  
  
  RESULTS
  PF incidence in patients with dark-red colored drainage fluid (16/51) was higher than in those without dark-red fluid (0/122, P < 0.0001). The sensitivity and specificity of diagnosis by fluid properties were 100% and 77.7%, respectively. PF formation also correlated with D-AMY level, with sensitivity and specificity of diagnosis by D-AMY level of 5,000 U of 100% and 82.2%, respectively. There were no differences in the above parameters between the two diagnostic methods.
  
  
  CONCLUSIONS
  Drainage fluid inspection can provide accurate diagnosis of PF formation, similar to D-AMY measurement, suggesting that routine D-AMY measurement is probably not necessary in every patient.
authors.affiliation: Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Tomimaru
authors.forename: Isao
authors.initials: I
authors.lastname: Miyashiro
authors.forename: Kentaro
authors.initials: K
authors.lastname: Kishi
authors.forename: Masaaki
authors.initials: M
authors.lastname: Motoori
authors.forename: Masahiko
authors.initials: M
authors.lastname: Yano
authors.forename: Tatsushi
authors.initials: T
authors.lastname: Shingai
authors.forename: Shingo
authors.initials: S
authors.lastname: Noura
authors.forename: Masayuki
authors.initials: M
authors.lastname: Ohue
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Ohigashi
authors.forename: Osamu
authors.initials: O
authors.lastname: Ishikawa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000681:Amylases / Q000378:metabolism*; D001826:Body Fluids / Q000378:metabolism; D003955:Diagnostic Tests, Routine; D004322:Drainage; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010185:Pancreatic Fistula / Q000175:diagnosis* / Q000201:enzymology / Q000209:etiology; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013274:Stomach Neoplasms / Q000150:complications / Q000201:enzymology* / Q000601:surgery*
chemical_list: D000681:Amylases