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. 2022 Aug;27(8):1273-1278.
doi: 10.1007/s10147-022-02177-x. Epub 2022 May 15.

Is the ISGPS definition of pancreatic fistula applicable after gastrectomy?

Tomoyuki Wakahara  1 , Susumu Miura  2 , Yuki Yasuhara  2 , Hideyo Mukubo  2 , Kiyonori Kanemitsu  2 , Takeshi Iwasaki  2 , Mitsuru Sasako  2
Affiliations

Is the ISGPS definition of pancreatic fistula applicable after gastrectomy?

Tomoyuki Wakahara et al. Int J Clin Oncol. 2022 Aug.

Abstract

Background: Pancreatic fistula is one of the most common and potentially fatal surgical complications after radical gastrectomy. The purpose of this study was to assess the validity of extrapolating the definition of pancreatic fistula by the International Study Group on Pancreatic Surgery to include situations surrounding gastric cancer surgery.

Methods: The clinicopathological data of 443 patients who underwent elective gastrectomy with suprapancreatic lymph node dissection (D1+, D2, or D2+ dissection) without pancreatic resection were reviewed. The relationship between postoperative pancreas-related complications (PPRC) and laboratory data, including drain fluid amylase levels on postoperative day 1 (dAmy1) and day 3 (dAmy3), were investigated.

Results: Twenty-four patients (5.4%) developed PPRC of ≥ grade II according to Clavien-Dindo classification. Among them, 15 patients had dAmy3 levels ≥ 375 IU/L, while all 24 patients had dAmy1 levels ≥ 375 IU/L. None of the patients with dAmy1 levels < 375 IU/L developed PPRC. The area under the curve of dAmy1 and dAmy3, calculated by drawing receiver operating characteristic curves, were 0.896 and 0.791, respectively. Univariate and multivariate analyses demonstrated that both dAmy1 and dAmy3 were significant predictors of PPRC; however, dAmy1 (p < 0.001) was more strongly correlated with PPRC than dAmy3 (p = 0.049).

Conclusions: DAmy1 is more sensitive than dAmy3 as an indicator of pancreatic fistula after gastric cancer surgery.

Keywords: Amylase; Gastrectomy; ISGPS definition; Pancreatic fistula.

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References

    1. Japanese Gastric Cancer Association (2021) Japanese gastric cancer treatment guidelines 2018 (5th edition). Gastric Cancer 24:1–21
    1. Kurokawa Y, Doki Y, Mizusawa J et al (2018) Bursectomy versus omentectomy alone for resectable gastric cancer (JCOG1001): a phase 3, open-label, randomized controlled trial. Lancet Gastroenterol Hepatol 3(7):460–468 - DOI
    1. Sano T, Sasako M, Mizusawa J et al. Stomach Cancer Study Group of the Japan Clinical Oncology Group (2017) Randomized controlled trial to evaluate splenectomy in total gastrectomy for proximal gastric carcinoma. Ann Surg 265(2):277–283
    1. Hiki N, Honda M, Etoh T et al (2018) Higher incidence of pancreatic fistula in laparoscopic gastrectomy. Real-world evidence from a nationwide prospective cohort study. Gastric Cancer 21(1):162–170 - DOI
    1. Uyama I, Suda K, Nakauchi M et al (2019) Clinical advantages of robotic gastrectomy for clinical stage I/II gastric cancer: a multi-institutional prospective single-arm study. Gastric Cancer 22(2):377–385 - DOI

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