Evaluation of Postoperative Pancreatic Fistula after Gastrectomy

Introduction : Although the safety of surgery for gastric cancer has improved, postoperative pancreatic fistula still occurs at a certain frequency. Pancreatic fistula is a serious complication which can lead to patient death, depending on its progress. Therefore, we investigated the risk factors for the occurrence of pancreatic fistula and management of the abdominal drainage tube. Method : Between January 2003 and June 2008, 418 patients underwent gastrectomy with D1 lymph node dissection for gastric cancer for the first time at our hospital. Of these cases, 4 patients underwent resection of the pancreas tail because of T4 status, and 1 patient underwent major hepatectomy. Eleven patients who suffered from abdominal abscess due to anastmotic leakage were excluded from the study, and the remaining 402 patients were included for analysis. Pancreatic fistula was diagnosed based on the findings of computed tomography and the characteristics of fluid from the abdominal drain tube. Results : Pancreatic fistula occurred in 23 patients (5.7%). Multivariate analysis revealed that BMI (p=0.004), procedure of gastrectomy (p=0.009) and the degree of lymph node dissection (p=0.019) were independent risk factors for pancreatic fistula. Seventeen (73.9%) of the 23 patients suffering from pancreatic fistula recovered without surgical intervention. Furthermore, the incidence of pancreatic fistula of patients with all three factors was 16.2%, while the incidence of the patients without any risk factor was 0.0%. Conclusion : We demonstrated that high BMI, total gastrectomy and suprapancreatic lymph node dissection were risk factors for postoperative pancreatic fistula in gastrectomy. Postoperative management of the abdominal drainage tube was required in consideration of these risk factors.