Postoperative Pancreatic Fistula and the Risk Factors of Laparoscopy-Assisted Distal Gastrectomy for Early Gastric Cancer

Jiang, Xiaohua; Hiki, Naoki; Nunobe, Souya; Kumagai, Koshi; Nohara, Kyoko; Sano, Takeshi; Yamaguchi, Toshiharu

doi:10.1245/s10434-011-1893-y

Cited by 70 publications

(67 citation statements)

References 29 publications

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“…However, neither after gastrectomy nor after pancreatic resection has evidence ASA score (n = 90) 0.2174 Pancreatic fistula after D2 gastrectomy 575 been presented to justify the routine use of such drains [21,22]. As shown in several other studies, we found that the dominating risk factor for POPF grade B and C was concomitant pancreatic resection, but determined no impact of BMI or splenectomy as in previous studies [10,11]. There was a minor effect of patient age on the risk of POPF.…”

Section: Discussionsupporting

confidence: 49%

“…In 2005 the International Study Group of Pancreatic Fistula (ISGPF) divided POPF into three degrees of severity. This definition has gained general acceptance in the literature covering pancreatic surgery [9] and the latest Japanese publications that report on POPF after gastrectomy have accordingly used the ISGPF definition [10][11][12]. To our knowledge, there is no corresponding information from the Western hemisphere, when this standardized classification has been used to describe the outcome of D2 gastrectomy, with particular emphasis on the impact of bursectomy.…”

Section: Introductionmentioning

confidence: 99%

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Postoperative pancreatic fistula formation according to ISGPF criteria after D2 gastrectomy in Western patients

et al. 2013

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Background Limited information is available on the incidence of postoperative pancreatic fistula (POPF) after D2 gastrectomy with the strict use of the International Study Group of Pancreatic Fistula (ISGPF) criteria, particularly so in Western patients. Methods All patients who underwent gastrectomy for adenocarcinoma at the Karolinska University Hospital Huddinge from 2006 until June 2012 were identified via hospital records and reviewed for type of surgical procedure, postoperative morbidity, incidence, and risk factors for POPF. Results Ninety-two of 107 cases had a D2 gastrectomy eligible for evaluation of POPF, of which 83 (90 %) also underwent bursectomy. Seven patients fulfilled the criteria for POPF grade A (7.6 %), 5 met the criteria for POPF grade B (5.4 %), and 6 the criteria for POPF grade C (6.5 %). The incidence of POPF grade B or C was 4.9 % among the 82 patients for whom no pancreatic resection was performed and 70 % among 10 cases with concomitant pancreatic resection. The latter (OR 156.2, 95 % CI 8.00-3046.93) and age (OR 1.2, 95 % CI 1.02-1.35) were found to be the only risk factors for POPF after gastrectomy upon a multivariate analysis.Conclusions In this series of Western patients, POPF grade B or C according to the ISGPF criteria was uncommon after D2 gastrectomy without pancreatic resection. Bursectomy was not a risk factor for POPF.

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Section: Discussionsupporting

confidence: 49%

Section: Introductionmentioning

confidence: 99%

Postoperative pancreatic fistula formation according to ISGPF criteria after D2 gastrectomy in Western patients

et al. 2013

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“…Many previous studies investigated the causes of POPF in total gastrectomy or laparoscopic gastrectomy. [8][9][10][16][17][18][19][20] However, this study aimed to identify the overall incidence and risk factors of POPF after various curative surgeries for gastric cancer patients.…”

Section: Discussionmentioning

confidence: 99%

“…However, there are few reports about POPF after curative gastrectomy for gastric cancer, especially about comparison between laparoscopic and open gastrectomy. [8][9][10] The purpose of this study is to evaluate the actual incidence and risk factors of POPF in both laparoscopic and open gastrectomy for gastric cancer during short concentrated two years in the experienced high volume center.…”

Section: Introductionmentioning

confidence: 99%

37. Risk factors of postoperative pancreatic fistula in curative gastric cancer surgery

Park

Jung

et al. 2014

European Journal of Surgical Oncology (EJSO)

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Purpose: Postoperative pancreatic fistula is a dreadful complication after gastric cancer surgery. The purpose of this study is to evaluate the actual incidence and risk factors of postoperative pancreatic fistula after curative gastrectomy for gastric cancer. Results: Overall, the postoperative pancreatic fistula rate was 3.3% (30/900) (1.5% in laparoscopic gastrectomy versus 6.9% in open gastrectomy, P<0.001). Patients who underwent D2 lymphadenectomy, total gastrectomy, splenectomy or distal pancreatectomy showed higher postoperative pancreatic fistula rates (4.7%, 13.8%, 13.6%, or 57.1%, respectively, P<0.001). Patients with postoperative pancreatic fistula had higher morbidity (46.7% versus 13.1%, P<0.001), delayed gas out (4.9 days versus 3.8 days, P<0.001), belated diet start (5.8 days versus 3.5 days, P<0.001) and longer postoperative hospital stay (13.7 days versus 6.8 days, P<0.001). On the multivariate analysis, total gastrectomy (odds ratio 9.751, 95% confidence interval: 3.348 to 28.397, P<0.001), distal pancreatectomy (odds ratio 7.637, 95% confidence interval: 1.668 to 34.961, P=0.009) and open gastrectomy (odds ratio 2.934, 95% confidence interval: 1.100 to 7.826, P=0.032) were the independent risk factors of postoperative pancreatic fistula. Conclusions: Laparoscopic gastrectomy had an advantage over open gastrectomy in terms of the lower postoperative pancreatic fistula rate. Total gastrectomy and combined resection, such as distal pancreatectomy, should be performed carefully to minimize postoperative pancreatic fistula in gastric cancer surgery.

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“…Ultrasonically activated devices (USADs) have been suspected to be associated with this complication [1,2], since they are widely used for lymph node dissection during laparoscopic gastric cancer surgery, and cavitation generated from the blade in USADs may have a harmful effect on various biological tissues [3][4][5][6]. In this study, we analyzed the mechanical and biological effects of USADs with two different types of blade and addressed the question of whether USADs could be the direct cause of POPF after laparoscopic gastric cancer surgery.…”

Section: Introductionmentioning

confidence: 99%

Analysis of mechanical and biological effects of ultrasonically activated devices

Lau

Gao

Sekine

et al. 2015

Acoust. Sci. & Tech.

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Postoperative Pancreatic Fistula and the Risk Factors of Laparoscopy-Assisted Distal Gastrectomy for Early Gastric Cancer

Abstract: LADG can be performed safely in patients with EGC in terms of the low incidence of POPF. To decrease the risk of POPF, LADG should be performed cautiously in male patients with high body mass index.

Cited by 70 publications

References 29 publications

Postoperative pancreatic fistula formation according to ISGPF criteria after D2 gastrectomy in Western patients

Postoperative pancreatic fistula formation according to ISGPF criteria after D2 gastrectomy in Western patients

37. Risk factors of postoperative pancreatic fistula in curative gastric cancer surgery

Analysis of mechanical and biological effects of ultrasonically activated devices

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