Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi‑ku, Hamamatsu, Shizuoka, 431‑3192, Japan.
Department of Perioperative Functioning Care and Support, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi‑ku, Hamamatsu, Shizuoka, 431‑3192, Japan.
Esophagus. 2021 Jul;18(3):522-528. doi: 10.1007/s10388-021-00827-z. Epub 2021 Feb 28.
Early diagnosis of anastomotic leakage (AL) after esophagectomy is essential to minimize postoperative complications. In this study, we hypothesized that drain amylase levels may be useful for early AL detection, and measuring drain amylase levels could reduce severe postoperative AL incidence. We, therefore, analyzed the usefulness of measuring drain fluid amylase levels after esophagectomy, in esophageal cancer patients.
From January 2016 to March 2020, 134 patients with esophageal cancer who underwent surgical resection with esophagogastric anastomosis in the cervical region were included. The patients were divided into a group whose cervical drain fluid amylase levels were not measured (No-AMY Group) and a group whose cervical drain fluid amylase levels were measured daily until postoperative day (POD) 7 (AMY Group). The incidence of severe AL was compared between groups. In the AMY Group, we also investigated the association between AL and drain amylase levels.
Drain amylase levels were significantly higher in AL-positive cases than in AL-negative cases (P < 0.001). Receiver operating characteristic curve analysis revealed the drain amylase level cut-off value for AL diagnosis was 1800 U/L on POD 2 (Area under the curve = 0.835; P = 0.027). The incidence of ≥ grade III AL was significantly lower in the AMY Group than in the No-AMY Group (2 vs. 10%, P = 0.047).
Cervical drain fluid amylase levels can be a useful screening method for early detection of AL after esophagectomy for esophageal cancer and may help reduce incidence of severe postoperative AL.
食管癌手术后早期诊断吻合口漏（AL）对于最大限度减少术后并发症至关重要。在本研究中，我们假设引流淀粉酶水平可能有助于早期 AL 的检测，并且测量引流淀粉酶水平可以降低严重术后 AL 的发生率。因此，我们分析了测量食管癌手术后引流液淀粉酶水平的有用性。
从 2016 年 1 月至 2020 年 3 月，共有 134 例接受颈段食管胃吻合术的食管癌患者纳入本研究。患者分为未测量颈引流液淀粉酶水平组（No-AMY 组）和每日测量颈引流液淀粉酶水平至术后第 7 天组（AMY 组）。比较两组严重 AL 的发生率。在 AMY 组中，我们还研究了 AL 与引流淀粉酶水平之间的关系。
AL 阳性组的引流淀粉酶水平明显高于 AL 阴性组（P<0.001）。受试者工作特征曲线分析显示，术后第 2 天诊断 AL 的引流淀粉酶水平截断值为 1800 U/L（曲线下面积 0.835；P=0.027）。AMY 组的≥Ⅲ级 AL 发生率明显低于 No-AMY 组（2%比 10%，P=0.047）。
颈引流液淀粉酶水平可以作为食管癌手术后早期检测 AL 的有用筛查方法，可能有助于降低严重术后 AL 的发生率。
