Accumulation of excess visceral fat is a risk factor for pancreatic fistula formation after total gastrectomy.
BACKGROUND
The effect of obesity on gastrectomy in patients with gastric cancer is controversial. The degree of abdominal fat increases the technical difficulty of abdominal surgery. This study examined the effect of visceral fat on total gastrectomy and risk factors associated with the formation of pancreatic fistula.


METHODS
Between February 2001 and April 2007, 191 patients with gastric cancer underwent total gastrectomy. The visceral fat area (VFA) was calculated from computed tomography (CT) scans taken at the level of the umbilicus using FatScan Software. Patients were divided into high- (> or =100 cm(2), n = 52) and low-VFA groups (<100 cm(2), n = 139), and also into high- (> or =25 kg/m(2), n = 47) and low-BMI groups (<25 kg/m(2), n = 144).


RESULTS
Blood loss and incidence of pancreatic fistula were significantly higher in the high- than low-VFA group. However, only blood loss was significantly different between the high- and low-BMI groups. VFA, blood loss, and splenectomy were identified as significant risk factors for pancreatic fistula formation on univariate analysis, and multivariate logistic regression analysis of these factors identified VFA (p = 0.0001) and splenectomy (p = 0.0014) as significant predictors of pancreatic fistula.


CONCLUSIONS
VFA is a better indicator for pancreatic fistula formation after total gastrectomy than is BMI. Lymph node dissection must be performed carefully, especially in patients with visceral fat accumulation during total gastrectomy with splenectomy.
Tanaka
Koji
K
Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Japan. tanaka-ko@mc.pref.osaka.jp
Miyashiro
Isao
I
Yano
Masahiko
M
Kishi
Kentaro
K
Motoori
Masaaki
M
Seki
Yousuke
Y
Noura
Shingo
S
Ohue
Masayuki
M
Yamada
Terumasa
T
Ohigashi
Hiroaki
H
Ishikawa
Osamu
O
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D006801:Humans; D050152:Intra-Abdominal Fat; D008197:Lymph Node Excision / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D010185:Pancreatic Fistula / Q000209:etiology*; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000150:complications / Q000601:surgery*; D055815:Young Adult