Impact of anatomical position of the pancreas on postoperative complications and drain amylase concentrations after laparoscopic distal gastrectomy for gastric cancer

  • Koshi Kumagai
  • Naoki Hiki
  • Souya Nunobe
  • Satoshi Kamiya
  • Masahiro Tsujiura
  • Satoshi Ida
  • Manabu Ohashi
  • Toshiharu Yamaguchi
  • Takeshi Sano



Laparoscopic surgery for gastric cancer requires traction or compression of the pancreas, with the extent depending on the anatomical position of the pancreas. This study investigated the impact of the position of the pancreas on postoperative complications and drain amylase concentrations after laparoscopic distal gastrectomy (LDG).


Gastric cancer patients who underwent LDG were assessed retrospectively. The following anatomical parameters were measured retrospectively in preoperative computed tomography sagittal projections: the length of the vertical line between the pancreas and the aorta (P–A length), representing the height of the slope looking down the celiac artery from the top of the pancreas, and the angle between a line drawn from the upper border of the pancreas to the root of the celiac artery and the aorta (UP–CA angle), representing the steepness of the slope. Correlations between each parameter and postoperative complications were analyzed by logistic regression analysis. Pearson’s product–moment correlation coefficients were calculated for scatter diagrams for each parameter and drain amylase concentration on postoperative day 1.


Analyses were performed in 394 patients. P–A length [odds ratio (OR) 1.905; 95% confidence interval (CI) 1.100–3.300; P = 0.021] was significantly correlated with pancreatic fistula. P–A length (OR 2.771; 95% CI 1.506–5.098; P = 0.001), UP–CA angle (OR 2.323; 95% CI 1.251–4.314; P = 0.008), and low preoperative serum albumin (OR 2.082; 95% CI 1.050–4.128; P = 0.036) were significantly correlated with overall postoperative complications defined as Clavien–Dindo ≥ grade II. P–A length and UP–CA angle showed significant positive correlations with drain amylase concentration on postoperative day 1.


The position of the pancreas is an independent predictor of pancreatic fistula and/or postoperative complications and correlates with drain amylase concentration after LDG for gastric cancer.


Stomach Cancer Pancreas Complication Anatomical position 


Compliance with ethical standards


Drs. Koshi Kumagai, Naoki Hiki, Souya Nunobe, Satoshi Kamiya, Masahiro Tsujiura, Satoshi Ida, Manabu Ohashi, Toshiharu Yamaguchi, and Takeshi Sano have no conflicts of interest or financial ties to disclose.

Ethical approval

All procedures involving human participants were carried out in accordance with the ethical standards of the institutional and/or national research committee, and in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The entire study was conducted with the approval of the institutional review board at the Cancer Institute Hospital (No. 1737). Informed consent was obtained from all individual participants included in the study. This article does not contain any studies with animals performed by any of the authors.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Koshi Kumagai
    • 1
  • Naoki Hiki
    • 1
  • Souya Nunobe
    • 1
  • Satoshi Kamiya
    • 1
  • Masahiro Tsujiura
    • 1
  • Satoshi Ida
    • 1
  • Manabu Ohashi
    • 1
  • Toshiharu Yamaguchi
    • 1
  • Takeshi Sano
    • 1
  1. 1.Department of Gastroenterological Surgery, Cancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan

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