title: Postoperative pancreatic fistula following surgery for gastric and pancreatic neoplasm; is distal pancreaticosplenectomy truly safe?
abstract: OBJECTIVE
  A pancreatic fistula is a potentially fatal complication in digestive tract surgery. The aim of this study was to review the prevention and treatment of pancreatic fistula as performed by our department.
  
  
  METHODS
  Three hundred and seventeen patients with gastric neoplasm and 34 patients with pancreatic neoplasm who underwent surgical resection between 1981 and 2001 at Kochi Medical School were studied. Comparative analysis of the incidence of pancreatic fistulae and the mortality rate was carried out according to an operation type and time.
  
  
  RESULTS
  Among the 317 patients who underwent total gastrectomy due to gastric neoplasm, 30 (9.5%) showed pancreatic fistulae. The incidence of pancreatic fistulae in patients who underwent distal pancreatectomy for pancreatic neoplasm was 29.4%. The mortality rate of patients who underwent total gastrectomy was 4.4% and there was a tendency for mortality rate to decrease in the second decade compared to the first. The mortality rate of patients who underwent distal pancreatectomy was 5.9%.
  
  
  CONCLUSIONS
  Mortality rate tended to decrease with advanced operative procedures, however, the incidence of pancreatic fistulae did not decrease. In pancreatic fistulae, it was found that the type of treatment was important. Intraoperative and postoperative drainage management for pancreaticosplenectomy will likely become much more important.
authors.affiliation: Department of Surgery, Kochi Medical School, Japan.
authors.forename: Takehiro
authors.initials: T
authors.lastname: Okabayashi
authors.forename: Michiya
authors.initials: M
authors.lastname: Kobayashi
authors.forename: Takeki
authors.initials: T
authors.lastname: Sugimoto
authors.forename: Ken
authors.initials: K
authors.lastname: Okamoto
authors.forename: Kimio
authors.initials: K
authors.lastname: Matsuura
authors.forename: Keijiro
authors.initials: K
authors.lastname: Araki
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects*; D010185:Pancreatic Fistula / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D013156:Splenectomy / Q000009:adverse effects*; D013274:Stomach Neoplasms / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome