Predictive Value Of Amylase Measurement In Abdominal Drainage Fluid For Postoperative Recovery And Discharge Risk After Laparoscopic Gastric Cancer Surgery

Objective: To explore the predictive value of drain amylase(DAMY)on postoperative recovery and discharge risk in patients who underwent laparoscopic radical gastrectomy for gastric cancer(GC).Methods: One hundred and eight patients undergoing laparoscopic radical gastrectomy were enrolled in the study.We use a relevant definition for ‘‘Normal Recovery'' defined as discharge within 9 days after surgery surgery,no major complications,readmissions to hospital,or mortality,virtuous and those which were considered to be ‘‘Delayed Recovery''.Patients considered to be ‘‘Delayed Recovery'' were divided into four grades(I-IV)and the predictive value of postoperative DAMY for postoperative recovery and discharge risk was assessed subsequently.Results: Thirty-six patients(33.3%)were considered to be delayed recovery,including 10 cases(9.3%)of Grade ? and 7 cases(6.5%)of Grade ?.Six of twenty patients(30%)without complications but reported delayed recovery were re-admitted within one month,and median hospital stay of those 6 patients was 9 days(8-11 days).Whether complications developed or not,DAMY on postoperative day 1(POD1)and postoperative day 3(POD3)were significantly increased in patients with delayed recovery.The time of first flatus and defecation,length of hospital stay were positively correlated with the POD1-DAMY and POD3-DAMY level,and serum level of C-reactive protein on POD3 were positively correlated with the POD3-DAMY level as while.The ROC curve and multivariate analysis showed that POD1-DAMY?1459 IU/L,POD3-DAMY?1150 IU/L,and POD3-serum-CRP?149.5mg/L were independent risk factors of postoperative recovery delay.When DAMY level takes the double-point cut-off value(POD1?1459 IU/L and POD3?1150 IU/L),the diagnostic ability of recovery delay is the highest(DOR=50.81).In addition,if POD3-DAMY fell more than 50.27% than POD1,or serum CRP<149.5mg/L on POD3,the risk of early discharge decreased for patients not satisfied with double-point cut-off values,otherwise,it should be more aware to the occurrence of complications,re-admission or invasive treatment.Conclusion: Continuous monitoring of peritoneal drainage amylase on the first and third day after laparoscopic gastric surgery has clinical significance in predicting postoperative recovery delay and early discharge risk.It is helpful to screen high-risk patients and make medical intervention on the early stage after surgery.Prospective studies are necessary to evaluate individualized risk of postoperative gastric cancer patients.