title: Evaluation of postoperative pancreatic fistula after total gastrectomy with D2 lymphadenectomy by ISGPF classification.
abstract: BACKGROUND
  Postoperative pancreatic fistula (POPF) is a serious complication of total gastrectomy (TG) with D2 lymphadenectomy (D2). However, the actual incidence and risk factors are not yet completely understood, due in part to the absence of the widely accepted criteria for POPF following gastrectomy.
  
  
  METHODS
  One hundred and four patients who underwent TG with D2 between March 2007 and December 2009 were included in this study. The incidence and severity of POPF were evaluated according to the International Study Group on Pancreatic Fistula (ISGPF) classification. In addition, risk factors for POPF of ISGPF grade B or higher were investigated.
  
  
  RESULTS
  POPFs of ISGPF grade B or higher were observed in 23 patients (22.1%). Univariate analysis found that sex, body mass index, and amylase concentration of drainage fluid (D: -AMY) on the first postoperative day (1POD) were significant predictors of POPF grade B or higher. The appropriate cutoff level of D: -AMY on 1POD was calculated as 3398 IU/l. Multivariate analysis showed that D: -AMY ≥3,398 IU/l on 1POD was the only independent risk factor.
  
  
  CONCLUSIONS
  High D: -AMY on 1POD (≥3,398 IU/l) can predict a grade B or higher POPF, and this value may be useful in the early detection of POPF following TG with D2.
authors.affiliation: Department of Gastric Surgery, Shizuoka Cancer Center, 1007, Shimonagakubo, Nagaizumi-cho, Shizuoka, 411-8777, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Miki
authors.forename: Masanori
authors.initials: M
authors.lastname: Tokunaga
authors.forename: Etsuro
authors.initials: E
authors.lastname: Bando
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Tanizawa
authors.forename: Taiichi
authors.initials: T
authors.lastname: Kawamura
authors.forename: Masanori
authors.initials: M
authors.lastname: Terashima
mesh_terms: D000368:Aged; D000681:Amylases / Q000032:analysis*; D015992:Body Mass Index; D004322:Drainage; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008197:Lymph Node Excision / Q000009:adverse effects*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010185:Pancreatic Fistula / Q000145:classification* / Q000453:epidemiology* / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D013274:Stomach Neoplasms / Q000473:pathology* / Q000601:surgery
chemical_list: D000681:Amylases