1
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Zhou M, Zhong G, Sun H, Zhu Q, Wang Z. Risk factors for postoperative pancreatic fistula (POPF) in gastric cancer patients: A systematic review and meta-analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:107092. [PMID: 37783104 DOI: 10.1016/j.ejso.2023.107092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/22/2023] [Accepted: 09/18/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND Postoperative pancreatic fistula (POPF) is a common and serious consequence of gastrectomy. The prevalence of POPF among patients with gastric cancer varies greatly, and the risk factors and outcomes of POPF are also controversial. The meta-analysis aims to comprehensively assess the risk factors for POPF in gastric cancer patients. METHODS PubMed, Web of Science, the Cochrane Library, Embase, and Chinese databases (SinoMed, CNKI, WanFang, and VIP Databases) were searched to identify relevant studies (from inception to May 2023). Two researchers evaluated the literature quality and extracted data individually. The Review Manager 5.4 program was used to analyze all of the data. RESULTS In our meta-analysis, 22 studies totaling 11,647 patients were analyzed. Male sex (OR = 3.06), older age (OR = 3.22), body mass index (BMI) ≥ 25 kg/m2 (OR = 2.58), visceral fat area (VFA) ≥ 100 cm2 (OR = 3.65), pTNM Ⅲ-Ⅳ (OR = 2.47), the number of lymphlode dissections (OR = 1.04), neoadjuvant chemotherapy (NAC) (OR = 2.91), the application of LigaSure (OR = 3.30), open surgery (OR = 3.23), intraoperative combined organ resection (OR = 4.11), drainage amylase concentration on the first postoperative day (OR = 5.73) and C-reactive protein on the 3rd postoperative day ≥20 mg/dL (OR = 7.29) were the risk factors for POPF in gastric cancer patients. On the other hand, the operation time (OR = 1.34) was not a risk factor for POPF. CONCLUSION The frequency of POPF in people undergoing gastrectomy was determined by a variety of risk factors. Medical professionals should identify risk factors early and impose interventions to prevent them to lower the incidence of POPF in gastric cancer patients.
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Affiliation(s)
- Ming Zhou
- Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Guangjun Zhong
- Baoying County People's Hospital, Yangzhou, Jiangsu Province, China
| | - Hui Sun
- Gaoyou City's People Hospital, Yangzhou, Jiangsu Province, China
| | - Qiaobo Zhu
- Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Zhengbing Wang
- Affiliated Hospital of Yangzhou University, Yangzhou, Jiangsu Province, China.
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2
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Miyai H, Fujita K, Saito M, Fujii Y, Saito T, Kato J, Sawai M, Eguchi Y, Hirokawa T, Yamamoto M, Kobayashi K, Takiguchi S. Solo surgery in robot-assisted gastrectomy versus laparoscopic gastrectomy for gastric cancer: a propensity score-matched analysis. Surg Endosc 2023:10.1007/s00464-023-10113-x. [PMID: 37308761 DOI: 10.1007/s00464-023-10113-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/03/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Robot-assisted gastrectomy (RG) for gastric cancer is still not well standardized. This study aimed to explore the feasibility and effectiveness of solo surgery in robot-assisted gastrectomy (SRG) for gastric cancer compared to laparoscopic gastrectomy (LG). METHODS This was a single-center retrospective comparative study between SRG and conventional LG. Between April 2015 and December 2022, 510 patients underwent gastrectomy, and data from a prospectively collected database were analyzed. We identified 372 patients who underwent LG (n = 267) and SRG (n = 105) and the remaining 138 patients were excluded because of remnant gastric cancer, esophagogastric junction cancer, open gastrectomy, concurrent surgery for concomitant malignancies, RG before starting SRG, or cases in which the author was unable to perform or supervise gastrectomy. Propensity score matching was performed at a ratio of 1:1 to reduce bias from confounding patient-related variables, and short-term outcomes were compared between the groups. RESULTS After propensity score matching, 90 pairs of patients who underwent LG and SRG were selected. In the propensity-matched cohort, the operation time was significantly shorter in the SRG group than that in the LG group (SRG = 305.7 ± 74.0 min vs. LG = 340.3 ± 91.65 min, p < 0.0058), less estimated blood loss was observed in the SRG group than that in the LG group (SRG = 25.6 ± 50.6 mL vs. LG = 76.1 ± 104.2 mL, p < 0.0001) and postoperative hospital stay was shorter in the SRG group than that in the LG group (SRG = 7.1 ± 0.8 days vs. LG = 9.1 ± 7.7 days, p = 0.015). CONCLUSION We found that SRG for gastric cancer was technically feasible and effective with favorable short-term outcomes, including shorter operative time, less estimated blood loss, shorter hospital stays, and lower postoperative morbidity than those in LG.
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Affiliation(s)
- Hirotaka Miyai
- Department of Gastroenterological Surgery, Kariya Toyota General Hospital, Kariya, Aichi, 448-8505, Japan.
| | - Kohei Fujita
- Department of Gastroenterological Surgery, Kariya Toyota General Hospital, Kariya, Aichi, 448-8505, Japan
| | - Masaki Saito
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, 467-8601, Japan
| | - Yoshiaki Fujii
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, 467-8601, Japan
| | - Tsuyoshi Saito
- Department of Gastroenterological Surgery, Kariya Toyota General Hospital, Kariya, Aichi, 448-8505, Japan
| | - Jyunki Kato
- Department of Gastroenterological Surgery, Kariya Toyota General Hospital, Kariya, Aichi, 448-8505, Japan
| | - Misato Sawai
- Department of Gastroenterological Surgery, Kariya Toyota General Hospital, Kariya, Aichi, 448-8505, Japan
| | - Yuki Eguchi
- Department of Gastroenterological Surgery, Kariya Toyota General Hospital, Kariya, Aichi, 448-8505, Japan
| | - Takahisa Hirokawa
- Department of Gastroenterological Surgery, Kariya Toyota General Hospital, Kariya, Aichi, 448-8505, Japan
| | - Minoru Yamamoto
- Department of Gastroenterological Surgery, Kariya Toyota General Hospital, Kariya, Aichi, 448-8505, Japan
| | - Kenji Kobayashi
- Department of Gastroenterological Surgery, Kariya Toyota General Hospital, Kariya, Aichi, 448-8505, Japan
| | - Shuji Takiguchi
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, 467-8601, Japan
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3
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Hayashi K, Inaki N, Sakimura Y, Yamaguchi T, Obatake Y, Terai S, Kitamura H, Kadoya S, Bando H. Pancreatic thickness as a predictor of postoperative pancreatic fistula after laparoscopic or robotic gastrectomy. Surg Endosc 2023:10.1007/s00464-023-10021-0. [PMID: 36997651 DOI: 10.1007/s00464-023-10021-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/12/2023] [Indexed: 04/01/2023]
Abstract
BACKGROUND Despite technical advances in minimally invasive gastrectomy for gastric cancer, an increased incidence of postoperative pancreatic fistula (POPF) has been reported. POPF can cause infectious and bleeding complications, which could lead to surgery-related death; therefore, reduction of the post-gastrectomy POPF risk is crucial. This study aimed to investigate the importance of pancreatic anatomy as a predictor of POPF in patients undergoing laparoscopic or robotic gastrectomy. METHODS Data were collected from 331 consecutive patients who underwent laparoscopic or robotic gastrectomy for gastric cancer. The thickness of the pancreas anterior to the most ventral level of the splenic artery (TPS) was measured. The correlation between TPS and POPF incidence was investigated using univariate and multivariate analyses. RESULTS The cutoff value of TPS was 11.8 mm, which predicted a high drain amylase concentration on postoperative day 1, and patients were categorized into thin (Tn group) and thick TPS groups (Tk group). There was no significant difference in the background characteristics between the two groups, except for sex (P = 0.009) and body mass index (P < 0.001). The incidences of POPF grade B or higher (2% vs. 16%, P < 0.001), all postoperative complications of grade II or higher (12% vs. 28%, P = 0.004), and postoperative intra-abdominal infections of grade II or higher (4% vs. 17%, P = 0.001) were significantly higher in the Tk group. Multivariable analysis identified that high TPS was the only independent risk factor for grade B or higher POPF and grade II or higher postoperative intra-abdominal infectious complications. CONCLUSIONS The TPS is a specific predictive factor for POPF and postoperative intra-abdominal infectious complications in patients undergoing laparoscopic or robotic gastrectomy. Careful pancreatic manipulation during suprapancreatic lymphadenectomy is necessary for patients with increased TPS (> 11.8 mm) to avoid postoperative complications.
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Affiliation(s)
- Kengo Hayashi
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kuratsukihigashi, 2 Chome-1, Kanazawa, Ishikawa, 920-8530, Japan.
| | - Noriyuki Inaki
- Department of Surgery, Kanazawa University Hospital, Kanazawa, Ishikawa, 920-8641, Japan
| | - Yusuke Sakimura
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kuratsukihigashi, 2 Chome-1, Kanazawa, Ishikawa, 920-8530, Japan
| | - Takahisa Yamaguchi
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kuratsukihigashi, 2 Chome-1, Kanazawa, Ishikawa, 920-8530, Japan
| | - Yoshinao Obatake
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kuratsukihigashi, 2 Chome-1, Kanazawa, Ishikawa, 920-8530, Japan
| | - Shiro Terai
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kuratsukihigashi, 2 Chome-1, Kanazawa, Ishikawa, 920-8530, Japan
| | - Hirotaka Kitamura
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kuratsukihigashi, 2 Chome-1, Kanazawa, Ishikawa, 920-8530, Japan
| | - Shinichi Kadoya
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kuratsukihigashi, 2 Chome-1, Kanazawa, Ishikawa, 920-8530, Japan
| | - Hiroyuki Bando
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kuratsukihigashi, 2 Chome-1, Kanazawa, Ishikawa, 920-8530, Japan
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4
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Martiniuc A, Dumitrascu T, Ionescu M, Tudor S, Lacatus M, Herlea V, Vasilescu C. Pancreatic Fistula after D1+/D2 Radical Gastrectomy according to the Updated International Study Group of Pancreatic Surgery Criteria: Risk Factors and Clinical Consequences. Experience of Surgeons with High Caseloads in a Single Surgical Center in Eastern Europe. J Gastric Cancer 2021; 21:16-29. [PMID: 33854810 PMCID: PMC8020004 DOI: 10.5230/jgc.2021.21.e3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 12/06/2020] [Accepted: 12/30/2020] [Indexed: 12/26/2022] Open
Abstract
Purpose Incidence, risk factors, and clinical consequences of pancreatic fistula (POPF) after D1+/D2 radical gastrectomy have not been well investigated in Western patients, particularly those from Eastern Europe. Materials and Methods A total of 358 D1+/D2 radical gastrectomies were performed by surgeons with high caseloads in a single surgical center from 2002 to 2017. A retrospective analysis of data that were prospectively gathered in an electronic database was performed. POPF was defined and graded according to the International Study Group for Pancreatic Surgery (ISGPS) criteria. Uni- and multivariate analyses were performed to identify potential predictors of POPF. Additionally, the impact of POPF on early complications and long-term outcomes were investigated. Results POPF was observed in 20 patients (5.6%), according to the updated ISGPS grading system. Cardiovascular comorbidities emerged as the single independent predictor of POPF formation (risk ratio, 3.051; 95% confidence interval, 1.161–8.019; P=0.024). POPF occurrence was associated with statistically significant increased rates of postoperative hemorrhage requiring re-laparotomy (P=0.029), anastomotic leak (P=0.002), 90-day mortality (P=0.036), and prolonged hospital stay (P<0.001). The long-term survival of patients with gastric adenocarcinoma was not affected by POPF (P=0.661). Conclusions In this large series of Eastern European patients, the clinically relevant rate of POPF after D1+/D2 radical gastrectomy was low. The presence of co-existing cardiovascular disease favored the occurrence of POPF and was associated with an increased risk of postoperative bleeding, anastomotic leak, 90-day mortality, and prolonged hospital stay. POPF was not found to affect the long-term survival of patients with gastric adenocarcinoma.
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Affiliation(s)
- Alexandru Martiniuc
- Department of General Surgery, Fundeni Clinical Institute, Bucharest, Romania.,Department of Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Traian Dumitrascu
- Department of General Surgery, Fundeni Clinical Institute, Bucharest, Romania.,Department of Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Mihnea Ionescu
- Department of General Surgery, Fundeni Clinical Institute, Bucharest, Romania
| | - Stefan Tudor
- Department of General Surgery, Fundeni Clinical Institute, Bucharest, Romania.,Department of Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Monica Lacatus
- Department of General Surgery, Fundeni Clinical Institute, Bucharest, Romania.,Department of Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Vlad Herlea
- Department of Pathology, Fundeni Clinical Institute, Bucharest, Romania.,Department of Pathology, Titu Maiorescu University, Bucharest, Romania
| | - Catalin Vasilescu
- Department of General Surgery, Fundeni Clinical Institute, Bucharest, Romania.,Department of Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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5
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Kinoshita J, Yamaguchi T, Saito H, Moriyama H, Shimada M, Terai S, Okamoto K, Nakanuma S, Makino I, Nakamura K, Tajima H, Ninomiya I, Fushida S. Comparison of prognostic impact of anatomic location of the pancreas on postoperative pancreatic fistula in laparoscopic and open gastrectomy. BMC Gastroenterol 2020; 20:325. [PMID: 33023478 PMCID: PMC7539397 DOI: 10.1186/s12876-020-01476-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 09/28/2020] [Indexed: 11/25/2022] Open
Abstract
Background Postoperative pancreatic fistula (POPF) is a serious complication after gastric cancer surgery. The current study aimed to investigate the significance of the anatomic location of the pancreas as a predictor for POPF in both laparoscopic gastrectomy (LG) and open gastrectomy (OG). Methods In total, 233 patients with gastric cancer were assessed retrospectively. We measured the maximum vertical (P-L height; PLH) and horizontal length (P-L depth; PLD) between the upper border of pancreas and the root of left gastric artery on a preoperative CT in the sagittal direction. The maximum length of the vertical line between the surface of the pancreas and the aorta (P-A length), previously reported as prognostic factor of POPF, was also measured. We investigated the correlations between these parameters and the incidence of POPF in LG and OG groups. Results Among the patients in this study, 118 underwent OG and 115 underwent LG. In LG, the median PLH and P-A length in patients with POPF were significantly longer compared with those without POPF (p = 0.026, 0.034, respectively), but not in OG. There was no significant difference in the median PLD between the patients with or without POPF in both LG and OG. The multivariate analysis demonstrated that PLH (odds ratio [OR] 4.19, 95% confidence interval [CI] 1.57–11.3, P = 0.004) and P-A length (OR 4.06, 95%CI 1.05–15.7, P = 0.042] were independent factors for predicting POPF in LG. However, intraoperative blood loss (OR 2.55, 95%CI 1.05–6.18, P = 0.038) was extracted as an independent factor in OG. The median amylase level in the drained fluid (D-Amy) were significantly higher in patients with high PLH(≥12.4 mm) or high P-A length (≥45 mm) compared with those with low PLH or low P-A length in LG. However, there were no differences in the D-Amy levels by PLH or P-A length in OG patients. Conclusions The anatomic location of the pancreas is a specific and independent predictor of POPF in LG but not in OG. PLH is a simple parameter that can evaluate the anatomic position of the pancreas, and it may be useful for preventing POPF after LG.
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Affiliation(s)
- Jun Kinoshita
- Department of Gastroenterological Surgery, Division of Cancer Medicine, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.
| | - Takahisa Yamaguchi
- Department of Gastroenterological Surgery, Division of Cancer Medicine, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Hiroto Saito
- Department of Gastroenterological Surgery, Division of Cancer Medicine, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Hideki Moriyama
- Department of Gastroenterological Surgery, Division of Cancer Medicine, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Mari Shimada
- Department of Gastroenterological Surgery, Division of Cancer Medicine, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Shiro Terai
- Department of Gastroenterological Surgery, Division of Cancer Medicine, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Koichi Okamoto
- Department of Gastroenterological Surgery, Division of Cancer Medicine, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Shinichi Nakanuma
- Department of Gastroenterological Surgery, Division of Cancer Medicine, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Isamu Makino
- Department of Gastroenterological Surgery, Division of Cancer Medicine, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Keishi Nakamura
- Department of Gastroenterological Surgery, Division of Cancer Medicine, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Hidehiro Tajima
- Department of Gastroenterological Surgery, Division of Cancer Medicine, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Itasu Ninomiya
- Department of Gastroenterological Surgery, Division of Cancer Medicine, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Sachio Fushida
- Department of Gastroenterological Surgery, Division of Cancer Medicine, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
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6
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Tanioka T, Kojima K, Saito T, Kanemoto E, Okuno K, Gokita K, Kobayashi K, Nakagawa M, Inokuchi M. Intraoperative Body Fluid Amylase as a Novel Indicator of Postgastrectomy Pancreatic Fistula. World J Surg 2019; 43:2061-2068. [PMID: 30903245 DOI: 10.1007/s00268-019-04961-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Although many methods to prevent the development of postoperative pancreatic fistula (POPF) after gastrectomy have been reported, POPF can only be identified after it has occurred. Various therapeutic measures could be taken if signs of POPF could be detected intraoperatively. METHODS We conducted a prospective study in which we attempted to predict POPF by measuring the intraoperative amylase concentration in the peripancreatic body fluid. To collect the body fluid, three sponges were placed around the pancreas at lymph node station Nos. 6, 8, and 11 during lymphadenectomy. The amylase concentration was measured in the body fluid squeezed from the sponges. We investigated whether the intraoperative body fluid amylase concentration (IBAC) was associated with POPF formation. RESULTS In total, 109 patients were enrolled from February 2016 to March 2018, and we analyzed 81 eligible patients. Clavien-Dindo grade ≥ II POPF occurred in eight patients (9%). The IBAC was significantly higher in sponges No. 6 (P = 0.044) and No. 8 (P = 0.007). The incidence of POPF was predicted by using an IBAC cutoff value for No. 6 (1047 IU/L; sensitivity 87.5%; specificity 65.0%; positive likelihood ratio 2.5) and No. 8 (400 IU/L; sensitivity 87.5%; specificity 68.5%; positive likelihood value 2.8), respectively. The IBAC in sponge No. 11 tended to be higher (P = 0.054). CONCLUSIONS By measuring the IBAC, surgeons might predict POPF easily and noninvasively during surgery. This method is one of the most effective ways to predict POPF intraoperatively.
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Affiliation(s)
- Toshiro Tanioka
- Department of Gastric Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan. .,Department of Minimally Invasive Treatment, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Kazuyuki Kojima
- Department of Gastric Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.,Department of Minimally Invasive Treatment, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshifumi Saito
- Department of Gastric Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.,Department of Minimally Invasive Treatment, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Emi Kanemoto
- Department of Gastric Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.,Department of Minimally Invasive Treatment, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Keisuke Okuno
- Department of Gastric Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.,Department of Minimally Invasive Treatment, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kentaro Gokita
- Department of Gastric Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.,Department of Minimally Invasive Treatment, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kenta Kobayashi
- Department of Gastric Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Masatoshi Nakagawa
- Department of Gastric Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Mikito Inokuchi
- Department of Gastric Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
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7
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HASBAHÇECİ M, CENGİZ MB, AKÇAKAYA A, MALYA FÜ, KUNDUZ E, BEKTAŞOĞLU HK. Impact of high amylase level in drainage fluid after gastric cancer surgery: Is it a complication or suspicious biochemical measurement? CUKUROVA MEDICAL JOURNAL 2019; 44:594-601. [DOI: 10.17826/cumj.450246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
Purpose: Pancreatic fistula is a
potential postoperative complication with variable definitions, incidences and
risk factors. We intended to evaluate its impact after gastric surgery. Materials and Methods: A total of 28 consecutive patients
who underwent curative open gastrectomy with lymphadenectomy for gastric
adenocarcinoma were retrospectively analyzed. Patients’ demographics,
peri-operative and pathological data were collected. Pancreatic fistula that
was diagnosed and graded according to International Study Group of Pancreatic
Fistula’s system was identified as main variable.Results: Mean age of
patients was 58.8±10.1 years with a female to male ratio of 9/19. Grade
A pancreatic fistula was diagnosed in six patients (21.4%). There was no grade B and C pancreatic
fistula. Drain amylase level was significantly higher in patients with
pancreatic fistula (p=0.0001). There was no significant difference with regard
to amount of drainage, length of hospital stay and duration of drains in
patients with and without fistula. No significant association was shown between
development of fistula and patients’ demographics, peri-operative and
pathological data.
Conclusion: The development of grade A
pancreatic fistula after gastric surgery does not appear to be a major
complication with clinical consequences. High amylase level in the drainage
fluid can be considered as a biochemical measure only.
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Affiliation(s)
| | | | - Adem AKÇAKAYA
- bezmialem vakıf üniversitesi tıp fakültesi genel cerrahi AD
| | | | - Enver KUNDUZ
- bezmialem vakıf üniversitesi tıp fakültesi genel cerrahi AD
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8
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Guerra F, Giuliani G, Formisano G, Bianchi PP, Patriti A, Coratti A. Pancreatic Complications After Conventional Laparoscopic Radical Gastrectomy Versus Robotic Radical Gastrectomy: Systematic Review and Meta-Analysis. J Laparoendosc Adv Surg Tech A 2018; 28:1207-1215. [PMID: 29733241 DOI: 10.1089/lap.2018.0159] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Recent reports have suggested that the use of the robot might reduce the rate of pancreatic complications following minimally invasive radical gastrectomy. METHODS By meta-analyzing the available literature, we aimed to elucidate possible differences between conventional laparoscopic and robotic radical gastrectomy on pancreatic morbidity. RESULTS More than 2000 patients from eight studies were eventually included in the analysis. The overall incidence of postoperative pancreatic complications was 2.2%, being 1.7% and 2.5% following robotic and laparoscopic gastrectomy (LG), respectively. In particular, pancreatic fistula occurred in 2.7% of patients receiving robotic gastrectomy (RG) and 3.8% of patients receiving laparoscopy. CONCLUSIONS The use of the robot showed a trend toward better outcomes compared with laparoscopy, despite the presence of more advanced disease and higher body mass index. The meta-analysis resulted in an odd ratio of 0.8 favoring RG over LG on pancreatic morbidity, although without statistical significance.
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Affiliation(s)
- Francesco Guerra
- 1 Division of General, Oncological, and Vascular Surgery, Ospedali Riuniti Marche Nord , Pesaro, Italy
- 2 Division of Oncological and Robotic General Surgery, Careggi University Hospital , Florence, Italy
| | - Giuseppe Giuliani
- 3 Division of General and Minimally Invasive surgery, Misericordia Hospital , Grosseto, Italy
| | - Giampaolo Formisano
- 3 Division of General and Minimally Invasive surgery, Misericordia Hospital , Grosseto, Italy
| | - Paolo Pietro Bianchi
- 3 Division of General and Minimally Invasive surgery, Misericordia Hospital , Grosseto, Italy
| | - Alberto Patriti
- 1 Division of General, Oncological, and Vascular Surgery, Ospedali Riuniti Marche Nord , Pesaro, Italy
| | - Andrea Coratti
- 2 Division of Oncological and Robotic General Surgery, Careggi University Hospital , Florence, Italy
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9
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Pancreas-related complications following gastrectomy: systematic review and meta-analysis of open versus minimally invasive surgery. Surg Endosc 2017; 31:4346-4356. [PMID: 28378074 DOI: 10.1007/s00464-017-5507-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 03/08/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Postoperative pancreas-related complications are quite uncommon but potentially life-threatening occurrences that may occasionally complicate the postoperative course of gastrectomy. A number of reports have described such conditions after both standard open and minimally invasive surgery. Our study has the purpose to systematically determine the pooled incidence of pancreatic events following radical gastrectomy. We also aimed to elucidate whether any difference in incidence exists between patients operated via conventional open or minimally invasive surgery. METHODS PubMed, EMBASE, and the Cochrane Library were systematically searched for randomized or well-matched studies comparing conventional with minimally invasive oncological gastrectomy and reporting pancreas-related postoperative complications. We evaluated possible differences in outcomes between open and minimally invasive surgery. A meta-analysis of relevant comparisons was performed using RevMan 5.3. RESULTS A total of 20 studies, whereby 6 randomized and 14 non-randomized comparative studies including a total of 7336 patients, were considered eligible for data extraction. Globally, more than 1% of patients experienced some pancreatic occurrences during the postoperative course. The use of minimally invasive surgery showed a trend toward increased overall pancreatic morbidity (OR 1.39), pancreatitis (OR 2.69), and pancreatic fistula (OR 1.13). CONCLUSIONS Although minimally invasive radical gastrectomy is currently established as a valid alternative to open surgery for the treatment of gastric cancer, a higher risk of pancreas-related morbidity should be taken into account.
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Migita K, Matsumoto S, Wakatsuki K, Ito M, Kunishige T, Nakade H, Nakatani M, Kitano M, Nakajima Y. The anatomical location of the pancreas is associated with the incidence of pancreatic fistula after laparoscopic gastrectomy. Surg Endosc 2016; 30:5481-5489. [PMID: 27126620 DOI: 10.1007/s00464-016-4909-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Accepted: 04/02/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND Postoperative pancreatic fistula (POPF) is one of the major complications after laparoscopic gastrectomy (LG). We investigated the impact of the anatomical location of the pancreas, especially in relation to the suprapancreatic lymph nodes, on the incidence of POPF after LG. METHODS We retrospectively reviewed the preoperative computed tomography (CT) images of 246 patients who underwent LG with the suprapancreatic lymph node dissection between November 2008 and November 2015. The length between the levels of the pancreatic body surface and the root of the common hepatic artery (LPC) was measured on a CT image with an axial view. A receiver operating characteristics (ROC) curve analysis was performed to determine the cutoff LPC value. A multivariate analysis was performed to determine the predictive factors for POPF. RESULTS POPF occurred in 11 patients (4.5 %). The median LPC was significantly longer in the patients with POPF than in those without (26 mm vs. 21 mm, p = 0.026). The ROC curve analysis revealed that the optimal cutoff LPC value for predicting POPF was 25 mm. The POPF rate was significantly higher in the long LPC group than in the short LPC group (10 vs. 1.3 %, p = 0.002). A multivariate analysis demonstrated that a long LPC (p = 0.018) and dissection of the lymph nodes along the distal splenic artery (p = 0.042) were independent predictors of POPF. The amylase level in the drainage fluid on postoperative day 1 was significantly higher in the long LPC group than in the short LPC group. CONCLUSIONS The LPC is a simple and reliable predictor of POPF after LG. Surgeons should take the anatomical location of the pancreas into consideration when performing LG with suprapancreatic lymph node dissection.
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Affiliation(s)
- Kazuhiro Migita
- Department of Surgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan.
| | - Sohei Matsumoto
- Department of Surgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Kohei Wakatsuki
- Department of Surgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Masahiro Ito
- Department of Surgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Tomohiro Kunishige
- Department of Surgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Hiroshi Nakade
- Department of Surgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Mitsuhiro Nakatani
- Department of Surgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Mutsuko Kitano
- Department of Surgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Yoshiyuki Nakajima
- Department of Surgery, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
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Lu X, Wang X, Fang Y, Chen H, Peng C, Li H, Deng X, Shen B. Systematic Review and Meta-Analysis of Pancreatic Amylase Value on Postoperative Day 1 After Pancreatic Resection to Predict Postoperative Pancreatic Fistula. Medicine (Baltimore) 2016; 95:e2569. [PMID: 26844462 PMCID: PMC4748879 DOI: 10.1097/md.0000000000002569] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Early detection of postoperative pancreatic fistula (POPF) may help to improve the outcome following pancreatic surgery, and exclusion of POPF may allow early drain removal which can accelerate recovery. The aim of this study was to evaluate the diagnostic accuracy of drain/plasma pancreatic amylase values on postoperative day 1 (DPA1/PPA1) in POPF by means of a systemic review and meta-analysis.Online journal databases and a manual search up to March 2015 were used. Studies clearly documenting DPA1 or PPA1 in predicting overall POPF (Grade 0 vs A+B+C) or clinically relevant POPF (Grade 0+A vs B+C) following pancreatic surgery were selected. Pooled predictive parameters were performed using STATA 12.0.Fifteen studies were finally identified with a total of 4331 patients. The pooled sensitivity and specificity of DPA1 were 0.92 (95% confidence interval (CI) 0.81-0.96) and 0.77 (95% CI 0.64-0.86) for predicting overall POPF and 0.79 (95% CI 0.61-0.90) and 0.83 (95% CI 0.74-0.89) for predicting clinically relevant POPF. The pooled sensitivity and specificity of PPA1 were 0.74 (95% CI 0.63-0.82) and 0.62 (95% CI 0.55-0.70) for overall POPF. After the DPA1 at/over cutoff values for overall POPF or clinically relevant POPF, corresponding post-test probability (Post-test (+)) (if pretest probability was 50%) was 80% and 82% respectively, while, if values were below the cutoff values, the post-test probability (Post-test (-)) was 10% and 20% respectively. Post-test (+) and Post-test (-) of PPA1 for overall POPF were 66% and 30% respectively. In subgroup analysis, the summary sensitivities of cutoff <1000 group and cutoff >1000 group were 0.96 (0.92-0.98) and 0.85 (0.64-0.95), respectively; the summary specificities were 0.59 (0.44-0.72) and 0.86 (0.80-0.91) respectively. Positive LR were 2.3 (1.7-3.3) and 6.2 (3.7-10.2) respectively. Negative LR were 0.06 (0.03-0.14) and 0.18 (0.07-0.47) respectively.DPA1 is a useful predictive test for overall POPF and clinically relevant POPF which has good sensitivity and specificity based on the current studies. Meanwhile, it should be cautiously applied to clinical practice because cutoffs had a wide range between studies.
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Affiliation(s)
- Xiongxiong Lu
- From the Pancreatic Disease Center; Research Institute of Pancreatic Disease; Shanghai Institute of Digestive Surgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Komatsu S, Ichikawa D, Kashimoto K, Kubota T, Okamoto K, Konishi H, Shiozaki A, Fujiwara H, Otsuji E. Risk factors to predict severe postoperative pancreatic fistula following gastrectomy for gastric cancer. World J Gastroenterol 2013; 19:8696-702. [PMID: 24379588 PMCID: PMC3870516 DOI: 10.3748/wjg.v19.i46.8696] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Revised: 09/17/2013] [Accepted: 09/29/2013] [Indexed: 02/06/2023] Open
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/mm(3) vs 1400/mm(3) ≤) 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.
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