Prevention of postoperative pancreatic fistula after total gastrectomy.
BACKGROUND
Pancreatic fistula (PF) is still one of the serious complications after total gastrectomy (TG). The purpose of this study was to identify risk factors for PF after TG and to evaluate our attempts to prevent PF.


METHODS
From August 1992 to July 2006, 740 consecutive patients with gastric neoplasm underwent TG at the National Cancer Center Hospital East. Univariate and multivariate analyses of potential risk factors for the development of PF and the effectiveness of operative procedures to prevent PF were performed.


RESULTS
Postoperative PF was identified in 130 patients (18%). On multivariate analysis, body mass index (P < 0.001) and the operative procedure (TG with pancreaticosplenectomy) (P = 0.001) were independent risk factors. In TG with splenectomy (pancreas-preserving method), total preservation of the splenic artery was significantly correlated with a lower incidence of PF (P < 0.001). In TG with pancreaticosplenectomy, the use of a linear stapling device was an effective surgical technique for closure of the cut end of the pancreas, but there was no significant difference from conventional methods. Recently, the incidence decreased significantly for TG overall and TG with splenectomy.


CONCLUSIONS
PF after TG is more likely to occur in obese patients undergoing TG with pancreaticosplenectomy. When TG with splenectomy (pancreas-preserving method) is performed, the splenic artery should be totally preserved. If TG with pancreaticosplenectomy is performed, the use of a linear stapling device for closure of the cut end of the pancreas should be suggested. These improvements in surgical techniques are useful to prevent PF.
Nobuoka
Daisuke
D
Department of Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, Japan. dnobuoka@east.ncc.go.jp
Gotohda
Naoto
N
Konishi
Masaru
M
Nakagohri
Toshio
T
Takahashi
Shinichiro
S
Kinoshita
Taira
T
D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D015992:Body Mass Index; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects* / Q000379:methods; D017052:Hospital Mortality; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010185:Pancreatic Fistula / Q000517:prevention & control*; D011183:Postoperative Complications / Q000517:prevention & control*; D012307:Risk Factors; D013156:Splenectomy / Q000379:methods; D013274:Stomach Neoplasms / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult