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

Abstract

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.

Two-point measurement of amylase in drainage fluid predicts severe postoperative pancreatic fistula after gastric cancer surgery

“…The diagnostic criteria for POPF have not been uniformly defined in the field of gastric cancer surgery, and instead the criteria for pancreatic surgery, International Study Group on Pancreatic Fistula (ISGPF) criteria, have been applied after gastrectomy [16,17]. In this study, we aimed to evaluate the 267 ability of D-AMY to predict clinically problematic POPF.…”

Impact of high amylase level in drainage fluid after gastric cancer surgery: Is it a complication or suspicious biochemical measurement?

“…Therefore, it has been shown that the incidence of complications after gastrectomy is directly related with the extent of the surgery. Additionally, pancreatic resection in association with gastrectomy has been shown to be an important and inevitable risk factor for POPF 5,7 . During the evaluation of POPF after gastrectomy, exclusion of these cases may help physicians to predict more accurate risk factors.…”

“…A clinically significant grade B pancreatic fistula was present if there was any change in the postoperative management, for example if drains were either left in place more than 3 weeks or repositioned through endoscopic or percutaneous procedures. A grade C fistula corresponded to the occurrence of severe clinical repercussions requiring reoperation or lead to single or multiple organ failure and/or mortality attributable to the pancreatic fistula 1,5,10 . Severe POPF were regarded as the cases with grade B or C pancreatic fistula.…”

“…Gastrectomy with radical lymph node dissection has been still considered as the standard treatment and it offers a better survival for gastric cancer compared with chemotherapy and radiotherapy 2 . D2 lymphadenectomy alone or in combination with splenectomy, or distal pancreatectomy has been regarded to be responsible for several complications including anastomotic leakage and postoperative pancreatic fistula (POPF) [3][4][5] . Intraabdominal abscess, sepsis, and severe pseudoaneurysmal bleedings may also develop as consequences of POPF 4 .…”

End-to-Side Penetrating-Suture Pancreaticojejunostomy: A Novel Anastomosis Technique

“…The excised portions included the head, neck and uncinate process of the pancreas, duodenum, distal stomach, proximal jejunum, gallbladder and common bile duct [10,11] . The tissue around the head of the pancreas and common hepatic duct, and the lymph nodes within the hepatoduodenal ligament were also resected.…”