Ishiyama Yasuhiro, Hirano Yasumitsu, Yamato Misuzu, Akuta Sohei, Yoshizawa Masatoshi, Fujii Takatsugu, Okazaki Naoto, Hiranuma Chikashi, Sakuramoto Shinichi
Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan.
Kawasaki Saiwai Hospital, Kawasaki, Japan.
Cancer Diagn Progn. 2024 Nov 3;4(6):802-807. doi: 10.21873/cdp.10399. eCollection 2024 Nov-Dec.
This study aimed to investigate the utility of measuring amylase levels in drainage fluid (DFA) for early, non-invasive detection of anastomotic leakage (AL) in undergoing low anterior resection (LAR) for rectal cancer.
This prospective observational cohort study analyzed drainage fluid samples from patients who underwent LAR for rectal cancer at two medical centers between February 2021 and December 2023. DFA levels were measured on postoperative days (PODs) 1, 3, and 5. AL was confirmed by clinical evidence and radiological imaging. Statistical analyses were performed to evaluate the diagnostic performance of DFA.
Of 120 LAR cases, AL occurred in five (4.16%). DFA levels on POD 3 and 5 were significantly higher in the AL than in the non-AL group (p<0.0001). DFA on POD 5 had the highest diagnostic accuracy for early AL detection, with an area under the curve of 0.99, achieving 100% sensitivity and 99.5% specificity at a cutoff of 846 U/l. A DFA >846 U/l predicted AL with negative predictive and positive predictive values of 83.3% and 100%, respectively, on POD 5.
Measuring DFA is a non-invasive, simple and cost-effective method for early AL detection in patients with rectal cancer undergoing LAR. Our findings also suggested that drain placement may be useful for the early detection of AL through DFA measurement.
本研究旨在探讨测量引流液淀粉酶水平（DFA）在直肠癌低位前切除术（LAR）中早期、非侵入性检测吻合口漏（AL）的效用。
这项前瞻性观察队列研究分析了2021年2月至2023年12月期间在两个医疗中心接受直肠癌LAR手术患者的引流液样本。在术后第1、3和5天测量DFA水平。通过临床证据和影像学检查确诊AL。进行统计分析以评估DFA的诊断性能。
在120例LAR病例中，有5例（4.16%）发生了AL。AL组术后第3天和第5天的DFA水平显著高于非AL组（p<0.0001）。术后第5天的DFA对早期AL检测具有最高的诊断准确性，曲线下面积为0.99，在临界值为846 U/l时，灵敏度达到100%，特异性为99.5%。术后第5天，DFA>846 U/l预测AL的阴性预测值和阳性预测值分别为83.3%和100%。
测量DFA是一种用于直肠癌LAR患者早期检测AL的非侵入性、简单且经济高效的方法。我们的研究结果还表明，放置引流管可能有助于通过DFA测量早期检测AL。
