Abstract
This study aimed to retrospectively investigate the predictive factors for pancreatic fistula following pancreaticosplenectomy. Pancreatic fistula is a major lethal complication of pancreaticosplenectomy. However, predictive factors for this condition have not yet been established. Between April 1992 and March 2000, 147 patients with advanced gastric cancer that was located predominantly in the upper third of the stomach were enrolled in this study. Predictive factors for pancreatic fistula were investigated using univariate and multivariate analyses. Pancreatic fistula, as de.ned according to our criteria, was observed in 73 (49.7%) patients. In the univariate analysis, age, body mass index, serum zinc level, hyperlipidemia, and comorbid disease all signi.cantly affected the incidence of pancreatic fistula. In the multivariate analysis, body mass index, hyperlipidemia, and comorbid disease independently predicted the occurrence of pancreatic fistula. By contrast, the experience of the operating surgeon had no significant effect on the frequency of this condition. Our results suggest that pancreaticosplenectomy, the surgical merit of which is not apparent, should be avoided whenever possible. If this operative procedure must be used (e.g., in patients with extensive tumor presence), careful manipulation and appropriate drainage are essential, particularly in cases showing predictive factors of pancreatic fistula.
Similar content being viewed by others
References
Cuschieri A, Weeden S, Fielding J, et al. Patients survival after D1 and D2 resections for gastric cancer: Long-term results of the MRC randomized surgical trial. Br J Cancer 1999;79:1522–1530.
Hartgrink HH, van de Velde CJ, Putter H, et al. Extended lymph node dissection for gastric cancer: Who may bene.t. Final results of the Randomized Dutch Gastric Cancer Group Trial? J Clin Oncol 2004;22:2069–2077.
Otsuji E, Yamaguchi T, Sawai K, Okamoto K, Takahashi T. Total gastrectomy with simultaneous pancreaticosplenectomy or splenectomy in patients with advanced gastric carcinoma. Br J Cancer 1999;79:1789–1793.
Takeuchi K, Tsuzuki Y, Ando T, et al. Total gastrectomy with distal pancreatectomy and splenectomy for advanced gastric cancer. J Surg Res 2001;101:196–201.
Kodera Y, Yamamura Y, Shimizu Y, et al. Lack of bene.t of combined pancreaticosplenectomy in D2 resection for proximal-third gastric carcinoma. World J Surg 1997;21:622–628.
Kitamura K, Nishida S, Ichikawa D, et al. No survival bene.t from combined pancreaticosplenectomy and total gastrectomy for gastric cancer. Br J Surg 1999;86:119–122.
Lo SS, Wu CW, Shen KH, Hsieh MC, Lui WY. Higher morbidity and mortality after combined total gastrectomy and pancreaticosplenectomy for gastric cancer. World J Surg 2002;26:678–682.
Yamamoto M, Baba H, Kakeji Y, et al. Postoperativemorbidity/ mortality and survival rates after total gastrectomy with splenectomy/ pancreaticosplenectomy for patients with advanced gastric cancer. Hepato-Gastroenterol 2004;51:298–302.
Sano T, Sasako M, Yamamoto S, et al. Gastric cancer surgery: Morbidity and mortality results from a prospective randomized controlled trial comparing D2 and extended para-aortic lymphadenectomy. Japan Clinical Oncology Group Study 9501. J Clin Oncol 2004;22:2767–2773.
Japanese Gastric Cancer Association. Japanese Classi.cation of Gastric Carcinoma: 2nd English Edition. Gastric Cancer 1998;1:10–24.
Maruyama K, Sasako M, Kinoshita T, Sano T, Katai H, Okajima K. Pancreas preserving total gastrectomy for proximal gastric cancer. World J Surg 1995;19:532–536.
Gretschel S, Christoph F, Bembenek A, Estevez-Schwarz L, Schneider U, Schlag PM. Body mass index does not affect systemicD2 lymph node dissection and postoperative morbidity in gastric cancer patients. Ann Surg Oncol 2003;10:363–368.
Barry JD, Blackshaw GR, Edwards P, et al. Western body mass indices need not compromise outcomes after modi.ed D2 gastrectomy for carcinoma. Gastric Cancer 2003;6:80–85.
Tsukada K, Miyazaki T, Kato H, et al. Body fat accumulation and postoperative complications after abdominal surgery. Am Surg 2004;70:347–351.
Inagawa S, Adachi S, Oda T, Kawamoto T, Koike N, Fukao K. Effect of fat volume on postoperative complications and survival rate after D2 dissection for gastric cancer. Gastric Cancer 2003;3:141–144.
van der Kallen CJ, Voors-Pette C, de Bruin TW. Abdominal obesity and expression of familial combined hyperlipidemia. Obes Res 2004;12:2054–2061.
Keaney JF Jr. Atherosclerosis: From lesion formation to plaque activation and endothelial dysfunction. Mol Aspects Med 2000;21:99–166.
Glaser J, Stienecker K. Pancreas and aging: A study using ultrasonography. Gerontology 2000;46:93–96.
Wang LS, Lin HY, Chang CJ, Fahn HJ, Huang MH, Lin CF. Effects of en bloc esophagectomy on nutritional and immune status in patients with esophageal carcinoma. J Surg Oncol 1998;67:90–98.
Delgado DRM, Gomez CC, Cos BAI, et al. Nutritional evaluation in patients with total gastrectomy. Nurs Hosp 2002;17:236–239.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kunisaki, C., Shimada, H., Ono, H. et al. Predictive factors for pancreatic fistula after pancreaticosplenectomy for advanced gastric cancer in the upper third of the stomach. J Gastrointest Surg 10, 132–137 (2006). https://doi.org/10.1016/j.gassur.2005.04.015
Issue Date:
DOI: https://doi.org/10.1016/j.gassur.2005.04.015