Published online Apr 14, 2020. doi: 10.3748/wjg.v26.i14.1594
Peer-review started: December 24, 2019
First decision: January 12, 2020
Revised: January 13, 2020
Accepted: March 22, 2020
Article in press: March 22, 2020
Published online: April 14, 2020
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.
Core tip: Many studies investigating postoperative pancreatic fistula after gastrectomy, including measurement of drain amylase content (D-AMY) as a predictive factor. This article reviews previous studies and looks to the future of measuring D-AMY in patients after gastrectomy. Several studies have reported that the high D-AMY on postoperative day 1 or day 3 was an independent risk factor for postoperative pancreatic fistula. However, issues for clinical use remain unresolved, including the ideal timing of measurement, optimal cut-off value and intervention after prediction. Prospective clinical trials might be indispensable for D-AMY to become a common marker in clinical practice.