title: Postoperative pancreatic fistula and the risk factors of laparoscopy-assisted distal gastrectomy for early gastric cancer.
abstract: BACKGROUND
  Laparoscopy-assisted distal gastrectomy (LADG) was introduced as minimally invasive surgery for early gastric cancer (EGC) in Japan. This study investigated postoperative pancreatic fistula (POPF) and associated risk factors of the procedure.
  
  
  METHODS
  From January 2005 to December 2009, 798 patients with EGC diagnosed before surgery underwent LADG. Thirty-four patients developed postoperative pancreatic fistula (POPF group), whereas the other 764 patients did not experience POPF (NPOPF group). POPF was defined and graded according to the International Study Group on Pancreatic Fistula Definition (ISGPF). Patient characteristics and operative and postoperative outcomes were compared between the two groups. Risk factors associated with POPF were analyzed.
  
  
  RESULTS
  POPF occurred in 34 (4.3%) patients; among them 3 developed grade C POPF, a complication that required aggressive clinical intervention, and only 1 underwent reoperation. Compared with the NPOPF group, the POPF group had higher percentage of male patients (88.2% vs. 60.5%, P = 0.001), higher mean body mass index (24.8 ± 2.5 kg/m(2) vs. 22.5 ± 3.2 kg/m(2), P < 0.001), longer mean operation time (251.3 ± 46.7 min vs. 229.7 ± 53.9 min, P = 0.022), higher postoperative complications (100% vs. 8.6%, P < 0.001), and longer mean postoperative hospital stay (29.6 ± 19.9 days vs. 12.6 ± 6.7 days, P < 0.001). Univariate and multivariate analysis identified sex and body mass index as risk factors associated with POPF after LADG.
  
  
  CONCLUSIONS
  LADG can be performed safely in patients with EGC in terms of the low incidence of POPF. To decrease the risk of POPF, LADG should be performed cautiously in male patients with high body mass index.
authors: Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
authors: Xiaohua
authors: X
authors: Jiang
authors: Naoki
authors: N
authors: Hiki
authors: Souya
authors: S
authors: Nunobe
authors: Koshi
authors: K
authors: Kumagai
authors: Kyoko
authors: K
authors: Nohara
authors: Takeshi
authors: T
authors: Sano
authors: Toshiharu
authors: T
authors: Yamaguchi
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010185:Pancreatic Fistula / Q000209:etiology* / Q000601:surgery; D011183:Postoperative Complications; D011184:Postoperative Period; D011379:Prognosis; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000150:complications / Q000601:surgery*