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. Conclusion: Fatty pancreas is a risk factor of POPF after radical gastrectomy.

Postoperative pancreatic fistula after gastrectomy for gastric cancer

“…such as BMI, 32,34,45,46 visceral fat area, 47 and fatty pancreas. 48 Jiang et al identified male sex as an independent predictor for postoperative pancreatic fistula as well as BMI in a multivariate analysis. 46 This may be due to difficulty in tissue handling and the vast area of visceral fat.…”

Obesity as a surgical risk factor

“…In contrast, although BMI routinely serves as an obesity index, the visceral fat area (VFA) is reportedly a more appropriate predictor of complications . Notably, VFA is often used as an obesity index for patients developing pancreatic fistula as a specific complication after gastrectomy, and an increase in VFA can serve as an important indicator of pancreatic fluid leakage risk …”

Analysis of pancreatic fistula risk in patients with laparoscopic pancreatoduodenectomy: what matters

“…Pancreaticoduodenectomy is an effective treatment for chronic pancreatitis, duodenal obstruction, pancreatic head lumps, lower common bile duct obstruction and pancreatic cancer, but the incidence of POPF remains relatively high. 19 With continuous improvements of medical technology and the progress and development of various suture techniques, the incidence of pancreatic fistula has been largely reduced, but the incidence of POPF remains as high as 10-30%, which poses a serious threat to the prognosis of patients. 20,21 In the present study, the incidence of postoperative pancreatic fistula was 20.15%, which is at the middle of the reported range for POPF incidence.…”