Abstract
BackgroundPostoperative pancreas fistula (POPF) is a major complication after total gastrectomy with splenectomy. We retrospectively studied the effects of upper abdominal shape on the development of POPF after gastrectomy.MethodsFifty patients who underwent total gastrectomy with splenectomy were studied. The maximum vertical distance measured by computed tomography (CT) between the anterior abdominal skin and the back skin (U-APD) and the maximum horizontal distance of a plane at a right angle to U-APD (U-TD) were measured at the umbilicus. The distance between the anterior abdominal skin and the root of the celiac artery (CAD) and the distance of a horizontal plane at a right angle to CAD (CATD) were measured at the root of the celiac artery. The CA depth ratio (CAD/CATD) was calculated.ResultsPOPF occurred in 7 patients (14.0%) and was associated with a higher BMI, longer CAD, and higher CA depth ratio. However, CATD, U-APD, and U-TD did not differ significantly between patients with and those without POPF. Logistic-regression analysis revealed that a high BMI (≥25) and a high CA depth ratio (≥0.370) independently predicted the occurrence of POPF (odds ratio = 19.007, p = 0.002; odds ratio = 13.656, p = 0.038, respectively).ConclusionSurgical procedures such as total gastrectomy with splenectomy should be very carefully executed in obese patients or patients with a deep abdominal cavity to decrease the risk of postoperative pancreatic fistula. BMI and body shape can predict the risk of POPF simply by CT.
Highlights
Postoperative pancreas fistula (POPF) is a major complication after total gastrectomy with splenectomy
Our study showed that a high body mass index (BMI) and larger upper abdomen independently influenced the risk of POPF in patients undergoing total gastrectomy with splenectomy for advanced gastric cancer
POPF developed in 49.7% of the patients who underwent total gastrectomy with pancreaticosplenectomy at our hospital, the present study showed that the incidence of POPF has decreased to 14.0% since the introduction of total gastrectomy with pancreas-preserving splenectomy in 2003 [22]
Summary
Postoperative pancreas fistula (POPF) is a major complication after total gastrectomy with splenectomy. We retrospectively studied the effects of upper abdominal shape on the development of POPF after gastrectomy. Gastrectomy with D2 lymph node dissection is an established procedure for the treatment of gastric cancer in Japan [1,2,3]. Japanese retrospective studies have shown that 20%–30% of patients with advanced cancer of the proximal stomach have nodal metastasis at the splenic hilum. The most frequent major complication after total gastrectomy with extended dissection is pancreatic fistula [3,5,6,7]. European clinical trials have shown that pancreatic complications are a major cause of mortality after gastrectomy [8,9]. Postoperative pancreatic complications are difficult to treat and prolong hospitalization
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
