title: Factors related to occurrence and aggravation of pancreatic fistula after radical gastrectomy for gastric cancer.
abstract: OBJECTIVE
  Pancreatic fistula (PF) and subsequent intra-abdominal abscess is a serious complication after gastrectomy for gastric cancer. The study aims to evaluate amylase concentration of drainage fluid (d-AMY) and serum C-reactive protein (CRP) as the predictive factors related to PF amounting to Clavien-Dindo (CD) grade III.
  
  
  METHODS
  448 patients who underwent gastrectomy for gastric cancer were analyzed. Closed drains were placed in the left subphrenic cavity and/or Winslow's cavity depending on the procedures. The cutoff values of d-AMY and CRP were determined, and their roles as predictive factors for CD grade III PF were evaluated.
  
  
  RESULTS
  PF, diagnosed in 58 patients, was stratified according to the CD classification. Consequently, grade III PF which includes PF-related abscesses was observed in 32 patients. The cutoff value of d-AMY on the first postoperative day for predicting grade III PF was 1949 IU/l. The cutoff value of CRP on the third postoperative day for the same purpose was 20.44 mg/dl. Multivariate analysis demonstrated that d-AMY and CRP were significant predictive factors for grade III PF.
  
  
  CONCLUSIONS
  The d-AMY on the first postoperative day and CRP on the third postoperative day might be useful for predicting CD grade III PF after gastrectomy.
authors.affiliation: Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kobayashi
authors.affiliation: Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Iwata
authors.affiliation: Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Japan.
authors.forename: Chie
authors.initials: C
authors.lastname: Tanaka
authors.affiliation: Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Japan.
authors.forename: Mitsuro
authors.initials: M
authors.lastname: Kanda
authors.affiliation: Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Japan.
authors.forename: Suguru
authors.initials: S
authors.lastname: Yamada
authors.affiliation: Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Japan.
authors.forename: Goro
authors.initials: G
authors.lastname: Nakayama
authors.affiliation: Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Fujii
authors.affiliation: Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Koike
authors.affiliation: Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Japan.
authors.forename: Michitaka
authors.initials: M
authors.lastname: Fujiwara
authors.affiliation: Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kodera
mesh_terms: D018784:Abdominal Abscess / Q000473:pathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004322:Drainage; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010185:Pancreatic Fistula / Q000209:etiology* / Q000473:pathology*; D011183:Postoperative Complications; D011379:Prognosis; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D055815:Young Adult
keywords: C-reactive protein; amylase concentration; drainage fluid; gastrectomy; gastric cancer; pancreatic fistula