title: Risk Factor of Pancreatic Fistula after Radical Gastrectomy from the Viewpoint of Fatty Pancreas.
abstract: BACKGROUND
  We suspected that fatty pancreas, accompanied with metabolic syndrome, may be associated with the incidence of postoperative pancreatic fistula (POPF) after radial gastrectomy.
  
  
  METHODS
  Between February 2012 and March 2014, we reviewed consecutive 79 gastric cancer patients who underwent radical gastrectomy. To quantify the degree of fatty infiltration to pancreas by preoperative contrast-enhanced CT, we measured ratios and differences between pancreatic and splenic attenuation values (P/S and P-S, respectively). The optimal cut-off values of P/S and P-S for predicting POPF were determined using the receiver operating characteristic (ROC) curve analysis. Risk factors for POPF of International Study Group on Pancreatic Fistula grade B or higher were examined using univariate and multivariate analyses.
  
  
  RESULTS
  POPF occurred in 6 patients (7.6%). ROC curve analyses revealed that the most optimal predictive values of P/S and P-S were 0.74 and -28.8, respectively. Univariate analysis demonstrated that high visceral fat area (p = 0.037), low P/S (p = 0.013), and low P-S (p = 0.006) were significant risk factors of POPF. Multivariate analysis demonstrated that low P/S (OR 10.2 [p = 0.046]) and low P-S (OR 13.2 [p = 0.023]) were significant risk factors of POPF.
  
  
  CONCLUSIONS
  Fatty pancreas is a risk factor of POPF after radical gastrectomy.
authors.affiliation: Department of Gastric Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Yuya
authors.initials: Y
authors.lastname: Sato
authors.forename: Mikito
authors.initials: M
authors.lastname: Inokuchi
authors.forename: Sho
authors.initials: S
authors.lastname: Otsuki
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Fujimori
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Kojima
mesh_terms: D050154:Adiposity; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D050152:Intra-Abdominal Fat / Q000000981:diagnostic imaging*; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications; D008875:Middle Aged; D010179:Pancreas / Q000000981:diagnostic imaging*; D010185:Pancreatic Fistula / Q000209:etiology*; D011183:Postoperative Complications / Q000209:etiology; D057234:Preoperative Period; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D013154:Spleen / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed
keywords: Fatty infiltration to pancreas; Fatty pancreas; Gastric cancer; Postoperative pancreatic fistula