Postoperative pancreatic fistula after gastrectomy for gastric cancer

Washio, Marie; Yamashita, Keishi; Hosoda, Kei; Hiki, Naoki

doi:10.1002/ags3.12398

Cited by 26 publications

(19 citation statements)

References 60 publications

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“…Performing splenectomy for station 10 lymphadenectomy did not in our experience induce an increase in mortality and morbidity. These complications were found to be severe, as reported in the literature[ 26 , 57 , 58 ]. Many studies show that risk factors for the development of pancreatic fistula are the weight of the patient, the anatomy and texture of the pancreas, intraoperative trauma of the pancreas and the use of high-energy devices when performing lymphadenectomy[ 26 , 57 ].…”

Section: Discussionsupporting

confidence: 63%

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Postoperative mortality and morbidity after D2 lymphadenectomy for gastric cancer: A retrospective cohort study

Brisinda¹,

Chiarello²,

Crocco³

et al. 2022

WJG

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BACKGROUND Surgery for gastric cancer is a complex procedure and lymphadenectomy is often mandatory. Postoperative mortality and morbidity after curative gastric cancer surgery is not insignificant. AIM To evaluate the factors determining mortality and morbidity in a population of patients undergoing R0 resection and D2 lymphadenectomy for gastric cancer. METHODS A retrospective analysis of clinical data and pathological characteristics (age, sex, primary site of the tumor, Lauren histotype, number of positive lymph nodes resected, number of negative lymph nodes resected, and depth of invasion as defined by the standard nomenclature) was conducted in patients with gastric cancer. For each patient we calculated the Kattan’s score. We arbitrarily divided the study population of patients into two groups based on the nomogram score (< 100 points or ≥ 100 points). Prespecified subgroups in these analyses were defined according to age (≤ 65 years or > 65 years), and number of lymph nodes retrieved (≤ 35 lymph nodes or > 35 lymph nodes). Uni- and multivariate analysis of clinical and pathological findings were performed to identify the factors affecting postoperative mortality and morbidity. RESULTS One-hundred and eighty-six patients underwent a curative R0 resection with D2 lymphadenectomy. Perioperative mortality rate was 3.8% (7 patients); a higher mortality rate was observed in patients aged > 65 years ( P = 0.002) and in N+ patients ( P = 0.04). Following univariate analysis, mortality was related to a Kattan’s score ≥ 100 points ( P = 0.04) and the presence of advanced gastric cancer ( P = 0.03). Morbidity rate was 21.0% (40 patients). Surgical complications were observed in 17 patients (9.1%). A higher incidence of morbidity was observed in patients where more than 35 lymph nodes were harvested ( P = 0.0005). CONCLUSION Mortality and morbidity rate are higher in N+ and advanced gastric cancer patients. The removal of more than 35 lymph nodes does not lead to an increase in mortality.

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Section: Discussionsupporting

confidence: 63%

“…Surgical treatment is still the mainstay of curative gastric cancer treatment[ 4 , 26 - 29 ]. For patients who undergo surgery, prognosis is determined by a series of factors, among which depth of invasion, nodal status, and metastasis are the most important.…”

Section: Discussionmentioning

confidence: 99%

Postoperative mortality and morbidity after D2 lymphadenectomy for gastric cancer: A retrospective cohort study

Brisinda¹,

Chiarello²,

Crocco³

et al. 2022

WJG

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“…In contrast, with LDG, risk factors for pancreatic fistula are related to the limited operating angle and field of view, which are specific to laparoscopic surgery. During suprapancreatic lymph node dissection with LDG, the forceps concentrate the force on one specific point, which then acts as a fulcrum resulting in the forceps applying a stronger force than is intended by the surgeon 33. In our institution, we retract the pancreas with a grasping gauze to avoid the force on one specific point.…”

Section: Discussionmentioning

confidence: 99%

“…During suprapancreatic lymph node dissection with LDG, the forceps concentrate the force on one specific point, which then acts as a fulcrum resulting in the forceps applying a stronger force than is intended by the surgeon. 33 In our institution, we retract the pancreas with a grasping gauze to avoid the force on one specific point. Nevertheless, increased pressure on the pancreas by the assistant surgeon’s forceps can contribute to the development of the pancreatic fistula.…”

Section: Discussionmentioning

confidence: 99%

“…However, the spread of minimally invasive surgery such as LDG and RDG is limited to the indication of OG, and we could not compare RDG with OG by the large difference of patients’ background. In the previous study, Washio et al 33 compared the incidence of postoperative pancreatic fistula after gastrectomy in previous reports and reported that the incidence of the pancreatic fistula was lower in RG compared with OG. In our study, we also showed the very low incidence of pancreatic fistula in RDG and speculated that RDG might not be inferior to OG in the incidence of pancreatic fistula.…”

Section: Discussionmentioning

confidence: 99%

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Robotic Distal Gastrectomy Reduces Drain Amylase Values in Patients With a Small Pancreas-left Gastric Artery Angle

Teranishi

Takahashi

Kurokawa

et al. 2022

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Purpose: Pancreatic fistula is a severe complication after laparoscopic distal gastrectomy (LDG). We previously evaluated the pancreas-left gastric artery angle (PLA) as a risk indicator for developing a pancreatic fistula after LDG. This study evaluated the incidence of pancreatic fistula with robotic distal gastrectomy (RDG) in comparison to LDG from the view of the PLA. Materials and Methods: An association between the PLA and the incidence of pancreatic fistula in 165 patients who underwent either RDG (n=45) or LDG (n=120) was investigated retrospectively. Results: RDG patients had significantly lower drain amylase values (postoperative day 2) than LDG patients. As opposed to LDG patients, drain amylase values were similar for patients with small (PLA <62 degrees) and large (PLA ≥62 degrees) PLA in RDG patients. Conclusion: Robotic surgery may reduce the risk of postoperative pancreatic fistula in patients with a small PLA.

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Short-term Outcomes of Robotic Gastrectomy vs Laparoscopic Gastrectomy for Patients With Gastric Cancer

et al. 2021

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IMPORTANCE Robotic gastrectomy (RG) for gastric cancer may be associated with decreased incidence of intra-abdominal infectious complications, including pancreatic fistula, leakage, and abscess. Prospective randomized clinical trials comparing laparoscopic gastrectomy (LG) and RG are thus required.OBJECTIVE To compare the short-term surgical outcomes of RG with those of LG for patients with gastric cancer. DESIGN, SETTING, AND PARTICIPANTSIn this phase 3, prospective superiority randomized clinical trial of RG vs LG regarding reduction of complications, 241 patients with resectable gastric cancer (clinical stages I-III) were enrolled between April 1, 2018, and October 31, 2020. INTERVENTIONSLG vs RG. MAIN OUTCOMES AND MEASURESThe primary end point was the incidence of postoperative intra-abdominal infectious complications. Secondary end points were incidence of any complications, surgical results, postoperative courses, and oncologic outcomes. The modified intention-to-treat population excluded patients who had been randomized and met the postrandomization exclusion criteria. There was also a per-protocol population for analysis of postoperative complications. RESULTSThis study enrolled 241 patients, with 236 patients in the modified intention-to-treat population (150 men [63.6%]; mean [SD] age, 70.8 [10.7] years). There was no significant difference in the incidence of intra-abdominal infectious complications (per-protocol population: 10 of 117 [8.5%] in the LG group vs 7 of 113 [6.2%] in the RG group). Of 241 patients, 122 were randomly assigned to the LG group, and 119 patients were randomly assigned to the RG group. Two of the 122 patients (1.6%) in the LG group converted from LG to open surgery, and 4 of 119 patients (3.4%) in the RG group converted from RG to open or laparoscopic surgery, with no significant difference. Finally, 117 patients in the LG group completed the procedure, and 113 in the RG group completed the procedure; these populations were defined as the per-protocol population. The overall incidence of postoperative complications of grade II or higher was significantly higher in the LG group (23 [19.7%]) than in the RG group (10 [8.8%]) (P = .02). Even in analysis limited to grade IIIa or higher, the complication rate was still significantly higher in the LG group (19 [16.2%]) than in the RG group (6 [5.3%]) (P = .01).CONCLUSIONS AND RELEVANCE This study found no reduction of intra-abdominal infectious complications with RG compared with LG for gastric cancer.TRIAL REGISTRATION umin.ac.jp/ctr Identifier: UMIN000031536

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Postoperative pancreatic fistula after gastrectomy for gastric cancer

Cited by 26 publications

References 60 publications

Postoperative mortality and morbidity after D2 lymphadenectomy for gastric cancer: A retrospective cohort study

Postoperative mortality and morbidity after D2 lymphadenectomy for gastric cancer: A retrospective cohort study

Robotic Distal Gastrectomy Reduces Drain Amylase Values in Patients With a Small Pancreas-left Gastric Artery Angle

Short-term Outcomes of Robotic Gastrectomy vs Laparoscopic Gastrectomy for Patients With Gastric Cancer

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