Establishment of a simple predictive scoring system for pancreatic fistula after laparoscopy‐assisted gastrectomy

Miyai, Hirotaka; Hara, Masayasu; Hayakawa, Tetsushi; Takeyama, Hiromitsu

doi:10.1111/den.12042

Cited by 14 publications

(10 citation statements)

References 31 publications

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“…The incidence of POPF after LG is reported to be 1.7 to 7.2% [ 4 , 7 , 11 , 25 , 26 ], and it was reported to be higher compared with after OG [ 7 , 13 – 15 ]. POPF is thought to be caused by several factors, including direct damage to the pancreas or lateral thermal injuries by surgical instruments.…”

Section: Discussionmentioning

confidence: 99%

Comparison of prognostic impact of anatomic location of the pancreas on postoperative pancreatic fistula in laparoscopic and open gastrectomy

et al. 2020

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Background Postoperative pancreatic fistula (POPF) is a serious complication after gastric cancer surgery. The current study aimed to investigate the significance of the anatomic location of the pancreas as a predictor for POPF in both laparoscopic gastrectomy (LG) and open gastrectomy (OG). Methods In total, 233 patients with gastric cancer were assessed retrospectively. We measured the maximum vertical (P-L height; PLH) and horizontal length (P-L depth; PLD) between the upper border of pancreas and the root of left gastric artery on a preoperative CT in the sagittal direction. The maximum length of the vertical line between the surface of the pancreas and the aorta (P-A length), previously reported as prognostic factor of POPF, was also measured. We investigated the correlations between these parameters and the incidence of POPF in LG and OG groups. Results Among the patients in this study, 118 underwent OG and 115 underwent LG. In LG, the median PLH and P-A length in patients with POPF were significantly longer compared with those without POPF (p = 0.026, 0.034, respectively), but not in OG. There was no significant difference in the median PLD between the patients with or without POPF in both LG and OG. The multivariate analysis demonstrated that PLH (odds ratio [OR] 4.19, 95% confidence interval [CI] 1.57–11.3, P = 0.004) and P-A length (OR 4.06, 95%CI 1.05–15.7, P = 0.042] were independent factors for predicting POPF in LG. However, intraoperative blood loss (OR 2.55, 95%CI 1.05–6.18, P = 0.038) was extracted as an independent factor in OG. The median amylase level in the drained fluid (D-Amy) were significantly higher in patients with high PLH(≥12.4 mm) or high P-A length (≥45 mm) compared with those with low PLH or low P-A length in LG. However, there were no differences in the D-Amy levels by PLH or P-A length in OG patients. Conclusions The anatomic location of the pancreas is a specific and independent predictor of POPF in LG but not in OG. PLH is a simple parameter that can evaluate the anatomic position of the pancreas, and it may be useful for preventing POPF after LG.

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Section: Discussionmentioning

confidence: 99%

Comparison of prognostic impact of anatomic location of the pancreas on postoperative pancreatic fistula in laparoscopic and open gastrectomy

et al. 2020

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“…Some researchers used the drained body fluid amylase concentration [8, 11] or C‐reactive protein concentration [8, 10]. One study used a predictive scoring system with risk factors such as age, drained amylase concentration, body mass index, and other parameters [7, 8, 10]. Although early findings of abnormalities and a quick response would lead to the prevention of severe POPF, the postoperative period might already be too late for effective therapy, or the drain might not be sufficient.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Body Fluid Amylase as a Novel Indicator of Postgastrectomy Pancreatic Fistula

et al. 2019

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Background Although many methods to prevent the development of postoperative pancreatic fistula (POPF) after gastrectomy have been reported, POPF can only be identified after it has occurred. Various therapeutic measures could be taken if signs of POPF could be detected intraoperatively. Methods We conducted a prospective study in which we attempted to predict POPF by measuring the intraoperative amylase concentration in the peripancreatic body fluid. To collect the body fluid, three sponges were placed around the pancreas at lymph node station Nos. 6, 8, and 11 during lymphadenectomy. The amylase concentration was measured in the body fluid squeezed from the sponges. We investigated whether the intraoperative body fluid amylase concentration (IBAC) was associated with POPF formation. Results In total, 109 patients were enrolled from February 2016 to March 2018, and we analyzed 81 eligible patients. Clavien-Dindo grade C II POPF occurred in eight patients (9%). The IBAC was significantly higher in sponges No. 6(P = 0.044) and No. 8 (P = 0.007). The incidence of POPF was predicted by using an IBAC cutoff value for No. 6 (1047 IU/L; sensitivity 87.5%; specificity 65.0%; positive likelihood ratio 2.5) and No. 8 (400 IU/L; sensitivity 87.5%; specificity 68.5%; positive likelihood value 2.8), respectively. The IBAC in sponge No. 11 tended to be higher (P = 0.054). Conclusions By measuring the IBAC, surgeons might predict POPF easily and noninvasively during surgery. This method is one of the most effective ways to predict POPF intraoperatively.

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“…Researchers have come up with different markers and models like DPA, PPA, CRP, WBC and many other indicators for the prediction. 1 , 5 – 7 , 17 , 31 – 33 Molinari et al 21 concluded that DPA1 > 5000 U/L was a significant predictive factor for POPF with a sensitivity and specificity of 93 and 84%, respectively. Sutcliffe et al 17 reported that using 350 U/L as a cutoff, low DPA1 excluded POPF with sensitivity, specificity, positive predictive value, and negative predictive value of 100, 79, 41 and 100%, respectively.…”

Section: Discussionmentioning

confidence: 99%

Systematic Review and Meta-Analysis of Pancreatic Amylase Value on Postoperative Day 1 After Pancreatic Resection to Predict Postoperative Pancreatic Fistula

et al. 2016

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Establishment of a simple predictive scoring system for pancreatic fistula after laparoscopy‐assisted gastrectomy

Cited by 14 publications

References 31 publications

Comparison of prognostic impact of anatomic location of the pancreas on postoperative pancreatic fistula in laparoscopic and open gastrectomy

Comparison of prognostic impact of anatomic location of the pancreas on postoperative pancreatic fistula in laparoscopic and open gastrectomy

Intraoperative Body Fluid Amylase as a Novel Indicator of Postgastrectomy Pancreatic Fistula

Systematic Review and Meta-Analysis of Pancreatic Amylase Value on Postoperative Day 1 After Pancreatic Resection to Predict Postoperative Pancreatic Fistula

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