title: Risk factors for pancreas-related abscess after total gastrectomy.
abstract: BACKGROUND
  European clinical trials of gastrectomy have shown that pancreas-related complications are the major cause of mortality. The aim of this study was to determine the risk factors for pancreas-related abscess after gastrectomy and to evaluate the effects of the abscess on postoperative mortality.
  
  
  METHODS
  Between 1992 and 1999, 663 consecutive patients with gastric carcinoma underwent total gastrectomy. Data from these patients were analyzed, to identify the predictors of pancreas-related abscess caused by pancreatic juice leakage, by a multiple logistic regression model.
  
  
  RESULTS
  On multivariate analysis, increasing age (P = 0.018) and body mass index (P = 0.006) were independent preoperative risk factors. Dissection along the distal splenic artery was an intraoperative risk factor. The hazard ratios were increased 9.13-fold (P = 0.000) with a pancreas-preserving operation and 16.72-fold (P = 0.000) by distal pancreatectomy. Patients with the abscess had a higher postoperative mortality rate (P = 0.008), and a higher re-operation rate (P < 0.001) than patients without the abscess.
  
  
  CONCLUSIONS
  Pancreas-related abscess is more likely to occur in older, obese patients undergoing node dissection along the distal splenic artery. Abscess formation is associated with a higher mortality and re-operation rate. Spleen preservation should be evaluated in Japan.
authors.affiliation: Department of Surgical Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Katai
authors.forename: Kimio
authors.initials: K
authors.lastname: Yoshimura
authors.forename: Takeo
authors.initials: T
authors.lastname: Fukagawa
authors.forename: Takeshi
authors.initials: T
authors.lastname: Sano
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Sasako
mesh_terms: D000038:Abscess / Q000209:etiology* / Q000401:mortality; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000209:etiology* / Q000401:mortality; D011183:Postoperative Complications; D012307:Risk Factors; D013156:Splenectomy; D013274:Stomach Neoplasms / Q000601:surgery; D015996:Survival Rate