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Pancreatic thickness as a predictor of postoperative pancreatic fistula after laparoscopic or robotic gastrectomy

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Abstract

Background

Despite technical advances in minimally invasive gastrectomy for gastric cancer, an increased incidence of postoperative pancreatic fistula (POPF) has been reported. POPF can cause infectious and bleeding complications, which could lead to surgery-related death; therefore, reduction of the post-gastrectomy POPF risk is crucial. This study aimed to investigate the importance of pancreatic anatomy as a predictor of POPF in patients undergoing laparoscopic or robotic gastrectomy.

Methods

Data were collected from 331 consecutive patients who underwent laparoscopic or robotic gastrectomy for gastric cancer. The thickness of the pancreas anterior to the most ventral level of the splenic artery (TPS) was measured. The correlation between TPS and POPF incidence was investigated using univariate and multivariate analyses.

Results

The cutoff value of TPS was 11.8 mm, which predicted a high drain amylase concentration on postoperative day 1, and patients were categorized into thin (Tn group) and thick TPS groups (Tk group). There was no significant difference in the background characteristics between the two groups, except for sex (P = 0.009) and body mass index (P < 0.001). The incidences of POPF grade B or higher (2% vs. 16%, P < 0.001), all postoperative complications of grade II or higher (12% vs. 28%, P = 0.004), and postoperative intra-abdominal infections of grade II or higher (4% vs. 17%, P = 0.001) were significantly higher in the Tk group. Multivariable analysis identified that high TPS was the only independent risk factor for grade B or higher POPF and grade II or higher postoperative intra-abdominal infectious complications.

Conclusions

The TPS is a specific predictive factor for POPF and postoperative intra-abdominal infectious complications in patients undergoing laparoscopic or robotic gastrectomy. Careful pancreatic manipulation during suprapancreatic lymphadenectomy is necessary for patients with increased TPS (> 11.8 mm) to avoid postoperative complications.

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Acknowledgements

We would like to thank Editage for the English language editing.

Funding

This research received no specific grant from any funding agency.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kuratsukihigashi, 2 Chome-1, Kanazawa, Ishikawa, 920-8530, Japan

    Kengo Hayashi, Yusuke Sakimura, Takahisa Yamaguchi, Yoshinao Obatake, Shiro Terai, Hirotaka Kitamura, Shinichi Kadoya & Hiroyuki Bando

  2. Department of Surgery, Kanazawa University Hospital, Kanazawa, Ishikawa, 920-8641, Japan

    Noriyuki Inaki

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  1. Kengo Hayashi
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Correspondence to Kengo Hayashi.

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Kengo Hayashi, Noriyuki Inaki, Yusuke Sakimura, Takahisa Yamaguchi, Yoshinao Obatake, Shiro Terai, Hirotaka Kitamura, Shinichi Kadoya, and Hiroyuki Bando have no conflicts of interest to disclose.

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Hayashi, K., Inaki, N., Sakimura, Y. et al. Pancreatic thickness as a predictor of postoperative pancreatic fistula after laparoscopic or robotic gastrectomy. Surg Endosc 37, 5358–5367 (2023). https://doi.org/10.1007/s00464-023-10021-0

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