title: Amylase concentration in drainage fluid as a predictive factor for severe postoperative pancreatic fistula in patients with gastric cancer.
abstract: OBJECTIVE
  Postoperative pancreatic fistula (PPF) sometimes occurs after gastrectomy. We examined the risk factors for severe PPF and evaluated the predictive value of amylase concentration in drainage fluid.
  
  
  METHODS
  We retrospectively reviewed 591 patients who underwent curative gastrectomy for gastric cancer. A multivariate analysis was conducted to identify the risk factors for severe PPF. Receiver operating characteristic curves were used to identify the appropriate amylase cut-off value to predict severe PPF.
  
  
  RESULTS
  Severe PPF occurred in 23 (3.9%) cases. The multivariate analysis indicated that splenectomy (P = 0.009) was the only significant risk factor. The area under the curve of amylase in drainage fluid for predicting severe PPF on postoperative day (POD) 3 was much greater than that on POD 1 (0.972 vs. 0.894). When the cut-off values for amylase were determined to be 2900 U/L on POD 1 and 2100 U/L on POD 3, the risk ratio for severe PPF on POD 3 was higher than that on POD 1 (99.2 vs. 30.2).
  
  
  CONCLUSIONS
  Splenectomy was an independent risk factor for severe PPF. An amylase level of 2100 U/L on POD 3 may be a reliable cut-off value for the early diagnosis of patients at high risk of severe PPF.
authors.affiliation: Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2, Yamadaoka, Suita, Osaka, Japan.
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Taniguchi
authors.affiliation: Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2, Yamadaoka, Suita, Osaka, Japan. ykurokawa@gesurg.med.osaka-u.ac.jp.
authors.forename: Yukinori
authors.initials: Y
authors.lastname: Kurokawa
authors.affiliation: Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2, Yamadaoka, Suita, Osaka, Japan.
authors.forename: Jota
authors.initials: J
authors.lastname: Mikami
authors.affiliation: Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2, Yamadaoka, Suita, Osaka, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Tanaka
authors.affiliation: Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2, Yamadaoka, Suita, Osaka, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Miyazaki
authors.affiliation: Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2, Yamadaoka, Suita, Osaka, Japan.
authors.forename: Tomoki
authors.initials: T
authors.lastname: Makino
authors.affiliation: Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2, Yamadaoka, Suita, Osaka, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Takahashi
authors.affiliation: Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2, Yamadaoka, Suita, Osaka, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Yamasaki
authors.affiliation: Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2, Yamadaoka, Suita, Osaka, Japan.
authors.forename: Kiyokazu
authors.initials: K
authors.lastname: Nakajima
authors.affiliation: Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2, Yamadaoka, Suita, Osaka, Japan.
authors.forename: Shuji
authors.initials: S
authors.lastname: Takiguchi
authors.affiliation: Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2, Yamadaoka, Suita, Osaka, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Mori
authors.affiliation: Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2, Yamadaoka, Suita, Osaka, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Doki
mesh_terms: D000328:Adult; D000368:Aged; D000681:Amylases / Q000032:analysis*; D015415:Biomarkers / Q000032:analysis; D001826:Body Fluids / Q000737:chemistry*; D004322:Drainage; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010185:Pancreatic Fistula / Q000175:diagnosis* / Q000209:etiology*; D011183:Postoperative Complications / Q000175:diagnosis* / Q000209:etiology*; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013156:Splenectomy / Q000009:adverse effects; D013274:Stomach Neoplasms / Q000601:surgery*
chemical_list: D015415:Biomarkers; D000681:Amylases
keywords: Amylase concentration; Gastric cancer; Pancreatic fistula