title: Accumulation of excess visceral fat is a risk factor for pancreatic fistula formation after total gastrectomy.
abstract: 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.
authors.affiliation: Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Japan. tanaka-ko@mc.pref.osaka.jp
authors.forename: Koji
authors.initials: K
authors.lastname: Tanaka
authors.forename: Isao
authors.initials: I
authors.lastname: Miyashiro
authors.forename: Masahiko
authors.initials: M
authors.lastname: Yano
authors.forename: Kentaro
authors.initials: K
authors.lastname: Kishi
authors.forename: Masaaki
authors.initials: M
authors.lastname: Motoori
authors.forename: Yousuke
authors.initials: Y
authors.lastname: Seki
authors.forename: Shingo
authors.initials: S
authors.lastname: Noura
authors.forename: Masayuki
authors.initials: M
authors.lastname: Ohue
authors.forename: Terumasa
authors.initials: T
authors.lastname: Yamada
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Ohigashi
authors.forename: Osamu
authors.initials: O
authors.lastname: Ishikawa
mesh_terms: 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