The Early Predictive Value Of Drainage Amylase Level For Esophagojejunostomy Anastomotic Leakage Following Laparoscopic Gastrectomy For Gastric Cancer

ObjectiveTo investigate the value of drainage amylase level for early diagnosis of esophagojejunostomy anastomotic leakage(EJAL)after laparoscopic gastrectomy.MethodsThis was a retrospective analysis including patients who underwent laparoscopic gastrectomy with esophagojejunostomy for gastric cancer from March 2019 to March 2022 in Guangdong Provincial People’s Hospital.A drainage tube was placed adjacent to the esophagojejunostomy anastomotic.Drainage amylase level was measured daily after surgery.Receiver operator characteristic(ROC)curves were created to assess the ability of amylase to early predict leakage.The Sensitivity,specificity,negative and positive predictive value of amylase were also calculated.We also compare the predictive efficacy of C-reactive protein(CRP)in blood and amylase levels in the drainage fluid in predicting esophagojejunal anastomotic leakage.ResultsFifty consecutive procedures were performed with drains,ten of them(20%)had a esophagojejunal anastomotic leakage and others had not a esophagojejunal anastomotic leakage.The median first clinical diagnosis day for patients with esophagojejunal anastomotic leakage was 5.5 days after surgery.Compare with patients without the esophagojejunal anastomotic leakage,the median daily amylase concentration in the drainage fluid in patients with the esophagojejunal anastomotic leakage was higher on 2-5 days after surgery.The optimal cutoff point was 252.5IU/L(the sensitivity was 84.6%,the specificity was 89.1%,P<0.001).Additionally,the area under the ROC curve of amylase in the drainage fluid on 2-5 days after surgery was 0.903 with good accuracy.The median daily CRP was relatively higher on 2-5 days after surgery with the esophagojejunal anastomotic leakage,with an optimal cutoff point of 117.9mg/L(the sensitivity 81.6%,the specificity was 74.6%,P<0.001).The area under the ROC curve of CRP on 2-5 days after surgery was 0.782.ConclusionThe determination of amylase in drainage fluid can early predict and identify the occurrence of esophagojejunal anastomotic leakage after laparoscopic total gastrectomy and proximal gastrectomy.The cutoff point of the concentration of amylase in the drainage fluid was 252.5IU/L and CRP in blood was117.9mg/L,respectively.Compared to CRP,the measurement of amylase concentration in drainage fluid had much better sensitivity and specificity,which can provide early warning and intervention for clinical doctors.The comprehensive reference of various indicators including drainage fluid amylase and CRP in blood can more accurately determine the risk of postoperative esophagojejunal anastomotic leakage in patients after laparoscopic gastrectomy.