Brief Article
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World J Gastroenterol. Dec 14, 2013; 19(46): 8696-8702
Published online Dec 14, 2013. doi: 10.3748/wjg.v19.i46.8696
Risk factors to predict severe postoperative pancreatic fistula following gastrectomy for gastric cancer
Shuhei Komatsu, Daisuke Ichikawa, Kingo Kashimoto, Takeshi Kubota, Kazuma Okamoto, Hirotaka Konishi, Atsushi Shiozaki, Hitoshi Fujiwara, Eigo Otsuji
Shuhei Komatsu, Daisuke Ichikawa, Kingo Kashimoto, Takeshi Kubota, Kazuma Okamoto, Hirotaka Konishi, Atsushi Shiozaki, Hitoshi Fujiwara, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
Author contributions: Komatsu S, Ichikawa D, Kashimoto K, Kubota T, Okamoto K, Konishi H, Shiozaki A, Fujiwara H and Otsuji E performed research; Komatsu S and Kashimoto K analyzed the data; Komatsu S wrote the paper.
Correspondence to: Shuhei Komatsu, MD, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachihirokoji, Kamigyo-ku, Kyoto 602-8566, Japan. skomatsu@koto.kpu-m.ac.jp
Telephone: +81-75-2515527 Fax: +81-75-2515522
Received: June 2, 2013
Revised: September 17, 2013
Accepted: September 29, 2013
Published online: December 14, 2013
Abstract

AIM: To allow the identification of high-risk postoperative pancreatic fistula (POPF) patients with special reference to the International Study Group on Pancreatic Fistula (ISGPF) classification.

METHODS: Between 1997 and 2010, 1341 consecutive patients underwent gastrectomy for gastric cancer at the Department of Digestive Surgery, Kyoto Prefectural University of Medicine, Japan. Based on the preoperative diagnosis, total or distal gastrectomy and sufficient lymphadenectomy was performed, mainly according to the Japanese guidelines for the treatment of gastric cancer. Of these, 35 patients (2.6%) were diagnosed with Grade B or C POPF according to the ISGPF classification and were treated intensively. The hospital records of these patients were reviewed retrospectively.

RESULTS: Of 35 patients with severe POPF, 17 (49%) and 18 (51%) patients were classified as Grade B and C POPF, respectively. From several clinical factors, the severity of POPF according to the ISGPF classification was significantly correlated with the duration of intensive POPF treatments (P = 0.035). Regarding the clinical factors to distinguish extremely severe POPF, older patients (P = 0.035, 65 years ≤vs < 65 years old) and those with lower lymphocyte counts at the diagnosis of POPF (P = 0.007, < 1400/mm3vs 1400/mm3≤) were significantly correlated with Grade C POPF, and a low lymphocyte count was an independent risk factor by multivariate analysis [P = 0.045, OR = 10.45 (95%CI: 1.050-104.1)].

CONCLUSION: Caution and intensive care are required for older POPF patients and those with lower lymphocyte counts at the diagnosis of POPF.

Keywords: Pancreatic fistula, International Study Group on Pancreatic Fistula classification, Gastric cancer, Gastrectomy, Complication

Core tip: Although several possible risk factors associated with the occurrence of postoperative pancreatic fistula (POPF) have been reported, there have been no generally accepted risk factors to predict POPF changing into extremely severe POPF. In this study, we demonstrated that older patients (P = 0.035) and those with lower lymphocyte counts at the diagnosis of POPF (P = 0.007) were significantly associated with extremely severe International Study Group on Pancreatic Fistula grade C POPF, and a low lymphocyte count was identified as an independent risk factor by multivariate analysis (P = 0.045, OR = 10.45).