Department of Surgery, University Hospital Split, Split, Croatia.
Department of Surgery, University Hospital Split, Split, Croatia.
Eur J Surg Oncol. 2021 Jun;47(6):1244-1251. doi: 10.1016/j.ejso.2020.12.005. Epub 2020 Dec 13.
Radical dissection of lymph nodes, accompanying gastric cancer resection, can lead to collateral damage to the pancreas and development of postoperative pancreatic fistula (POPF).
We searched the Cochrane Library, MEDLINE, Embase, and Web of Science up to April 21, 2020, to identify studies documenting the value of abdominal drain amylase level (d-AMY) on postoperative day 1 (POD1) as a predictor of POPF after gastric surgery. The quality of selected studies was assessed using the QUADAS-2 tool. The diagnostic value of d-AMY on POD1 for prediction of POPF was first assessed by calculation of pooled estimates of sensitivity, specificity, likelihood ratios (LR), and the diagnostic odds ratio (DOR). Secondly, the accuracy was further demonstrated graphically with the hierarchical summary receiver operating curve (hSROC). PROSPERO registration number: CRD42020181145.
DOR of nine studies (cases n = 1856) observing the occurrence of POPF after measurement of d-AMY on POD1 was 18.7 (95%CI: 10.0, 34.8), and the area under hSROC was 0.88 ± 0.02. The pooled sensitivity was 0.74 (95%CI: 0.66, 0.81) and specificity 0.84 (95%CI: 0.82, 0.86). The negative LR was at the lowest point of 0.16 (95%CI: 0.07, 0.37) at the cutoff value for d-AMY of 941 IU/L, while the positive LR ranged from 4.4 (cutoff 2119 IU/L) to 6.2 (cutoff 5000 IU/L).
d-AMY on POD1 can be used as an accurate and non-invasive predictor of POPF in the earliest stage of postoperative course following gastric cancer resection; value ≤ 941 IU/L warrants early drain removal and low probability of POPF (any grade).
淋巴结根治性清扫术伴随胃癌切除术可能导致胰腺的附带损伤和术后胰瘘（POPF）的发生。
我们检索了 Cochrane 图书馆、MEDLINE、Embase 和 Web of Science，截至 2020 年 4 月 21 日，以确定记录术后第 1 天（POD1）腹引流淀粉酶水平（d-AMY）作为胃癌手术后 POPF 预测因子价值的研究。使用 QUADAS-2 工具评估所选研究的质量。首先通过计算敏感性、特异性、似然比（LR）和诊断比值比（DOR）的汇总估计值，评估 POD1 时 d-AMY 对 POPF 预测的诊断价值。其次，通过层次汇总受试者工作特征曲线（hSROC）图形进一步展示准确性。PROSPERO 注册号：CRD42020181145。
在测量 POD1 时 d-AMY 后观察到 POPF 发生的 9 项研究（病例 n=1856）的 DOR 为 18.7（95%CI：10.0，34.8），hSROC 的曲线下面积为 0.88±0.02。汇总敏感性为 0.74（95%CI：0.66，0.81），特异性为 0.84（95%CI：0.82，0.86）。阴性 LR 在 d-AMY 截断值为 941IU/L 时最低，为 0.16（95%CI：0.07，0.37），阳性 LR 范围从 4.4（截断值 2119IU/L）到 6.2（截断值 5000IU/L）。
POD1 时的 d-AMY 可作为胃癌切除术后早期术后过程中 POPF 的准确、非侵入性预测因子；值≤941IU/L 提示早期引流管去除和 POPF（任何等级）发生的可能性低。
