Serial Drain Amylase Can Accurately Detect Anastomotic Leak After Esophagectomy and May Facilitate Early Discharge Yaron Perry, MD, Christopher W. Towe,

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Presentation transcript:

Serial Drain Amylase Can Accurately Detect Anastomotic Leak After Esophagectomy and May Facilitate Early Discharge Yaron Perry, MD, Christopher W. Towe, MD, Jonathan Kwong, MD, Vanessa P. Ho, MD, Philip A. Linden, MD The Annals of Thoracic Surgery Volume 100, Issue 6, Pages 2041-2047 (December 2015) DOI: 10.1016/j.athoracsur.2015.05.092 Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Characterization of postesophagectomy anastomotic leaks by grade. Grade I = local defect requiring no change in therapy or treated medically or with dietary modification; grade II = localized defect requiring interventional (eg, interventional radiology drain, stent, or bedside opening and packing of incision) but not surgical therapy; grade III = localized defect requiring surgical therapy. The Annals of Thoracic Surgery 2015 100, 2041-2047DOI: (10.1016/j.athoracsur.2015.05.092) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Receiver operating characteristic (ROC) curve for all leaks on postoperative day 4. A drain amylase cutoff value of 23 IU/L (*) on postoperative day 4 was 95.5% sensitive and 48.2% specific for detecting all esophageal leaks, which implies a false negative rate of less than 5%. A cutoff value of 234 IU/L (†) was 50% sensitive and 97.7% specific for any kind of leak, and accurately classified 88.2% of patients. The Annals of Thoracic Surgery 2015 100, 2041-2047DOI: (10.1016/j.athoracsur.2015.05.092) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Receiver operating characteristic (ROC) for the association of drain amylase and grade II and III leaks on postoperative day 4. A cutoff of 38 IU/L (*) was 100% sensitive and 52.0% specific for detection of a clinically significant leak. A value of 250 IU/L (†) was 66.7% sensitive and 95.5% specific for a clinically significant leak and accurately classified 92.7% of patients. Grade II = localized defect requiring interventional (eg, interventional radiology drain, stent, or bedside opening and packing of incision) but not surgical therapy; grade III = localized defect requiring surgical therapy. The Annals of Thoracic Surgery 2015 100, 2041-2047DOI: (10.1016/j.athoracsur.2015.05.092) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions