Abstract
The clinical courses of 178 consecutive patients undergone distal pancreatectomy with gastrectomy for gastric cancer in our department during last 11 years were reviewed, to identify the risk factors related to the development of postoperative pancreatic fistulas. In addition, the usefulness of fibrin glue applied to the stump of pancreas to prevent postoperative pancreatic fistula was also studied. Postoperative pancreatic fistula was present in 43 patients (24.2%). The increased incidence of postoperative pancreatic fistula was observed in patients associated with preoperative disorder of glucose metabolism or liver disfunction, those with far advanced gastric cancer, and those without intraoperative ligation of pancreatic duct on the cut-surface. However, in the courses of 135 patients with suitable ligation of pancreatic duct, 30 pancreatic fistulas (24.6%) occurred postoperatively among 122 patients without the use of fibrin glue, versus only one pancreatic fistula (7.7%) among 13 patients with fibrin glue. These results suggest that optimal evaluation of risk factors can link prevention of postoperative pancreatic fistula and that application of fibrin glue to the stump of pancreas after suitable ligation of pancreatic duct might be useful to prevent from postoperative pancreatic fistula.
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