Risk factors of postoperative pancreatic fistula in curative gastric cancer surgery

Hyeong Won Yu, Do Hyun Jung, Sang Yong Son, Chang Min Lee, Ju Hee Lee, Sang Hoon Ahn, Do Joong Park, Hyung Ho Kim

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

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. Materials and Methods: A total of 900 patients who underwent gastrectomy for gastric cancer (laparoscopic gastrectomy, 594 patients; open gastrectomy 306 patients) were enrolled between January 2009 and December 2010. Clinical outcomes, including postoperative pancreatic fistula grade based on the International Study Group on Pancreatic Fistula, were investigated. 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.

Original languageEnglish
Pages (from-to)179-184
Number of pages6
JournalJournal of Gastric Cancer
Volume13
Issue number3
DOIs
Publication statusPublished - 2013 Oct 10
Externally publishedYes

Fingerprint

Pancreatic Fistula
Gastrectomy
Stomach Neoplasms
Pancreatectomy
Odds Ratio
Confidence Intervals
Splenectomy
Lymph Node Excision
Length of Stay

Keywords

  • Gastrectomy
  • Pancreatic fistula
  • Risk factors
  • Stomach cancer

ASJC Scopus subject areas

  • Oncology
  • Gastroenterology
  • Cancer Research

Cite this

Risk factors of postoperative pancreatic fistula in curative gastric cancer surgery. / Yu, Hyeong Won; Jung, Do Hyun; Son, Sang Yong; Lee, Chang Min; Lee, Ju Hee; Ahn, Sang Hoon; Park, Do Joong; Kim, Hyung Ho.

In: Journal of Gastric Cancer, Vol. 13, No. 3, 10.10.2013, p. 179-184.

Research output: Contribution to journalArticle

Yu, Hyeong Won ; Jung, Do Hyun ; Son, Sang Yong ; Lee, Chang Min ; Lee, Ju Hee ; Ahn, Sang Hoon ; Park, Do Joong ; Kim, Hyung Ho. / Risk factors of postoperative pancreatic fistula in curative gastric cancer surgery. In: Journal of Gastric Cancer. 2013 ; Vol. 13, No. 3. pp. 179-184.
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abstract = "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. Materials and Methods: A total of 900 patients who underwent gastrectomy for gastric cancer (laparoscopic gastrectomy, 594 patients; open gastrectomy 306 patients) were enrolled between January 2009 and December 2010. Clinical outcomes, including postoperative pancreatic fistula grade based on the International Study Group on Pancreatic Fistula, were investigated. 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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AB - 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. Materials and Methods: A total of 900 patients who underwent gastrectomy for gastric cancer (laparoscopic gastrectomy, 594 patients; open gastrectomy 306 patients) were enrolled between January 2009 and December 2010. Clinical outcomes, including postoperative pancreatic fistula grade based on the International Study Group on Pancreatic Fistula, were investigated. 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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