Amylase concentration of the drainage fluid as a risk factor for intra-abdominal abscess following gastrectomy for gastric cancer.

Abstract

Insertion of drainage tubes at gastric cancer surgery could be useful for the prediction and management of postoperative complications. However, drains should be removed as soon as they are deemed unnecessary for various reasons. Amylase concentration of the drainage fluid following total gastrectomy for gastric cancer has been reported to be a useful risk factor for surgical complications. Between January 2002 and December 2008, the authors measured amylase concentration of the drainage fluid on the first postoperative day for 372 patients who underwent gastrectomy with lymphadenectomy for gastric cancer at the Department of Surgery II, Nagoya University. Univariate and multivariate analyses were performed to evaluate the significance of various covariates as risk factors for the pancreas-related complications. Postoperative complications developed in 111 patients, of which 27 were pancreas-related. Amylase concentration was significantly higher in patients who underwent splenectomy, pancreaticosplenectomy, total/proximal gastrectomies, and extended lymphadenectomy and in those who eventually developed intra-abdominal abscess. Amylase concentration > or =1,000 IU/l on the first postoperative day, along with the body mass index, was an independent risk factor for pancreas-related intra-abdominal abscess. With a negative predictive value of 97.7%, pancreas-related complications are highly unlikely to be observed when amylase concentration is less than 1,000 IU/l, and early removal of the drainage tube could be recommended for these patients.