process of pancreas head as a risk factor for postoperative pancreatic fistula in laparoscopic gastric cancer surgery.过程中胰腺头作为术后胰瘘的危险因素在腹腔镜胃癌手术.pdfVIP

World J Surg (2016) 40:2194–2201 DOI 10.1007/s00268-016-3536-8 ORIGINAL SCIENTIFIC REPORT Process of Pancreas Head as a Risk Factor for Postoperative Pancreatic Fistula in Laparoscopic Gastric Cancer Surgery Nao Kobayashi1 • Hisashi Shinohara1,2 • Shusuke Haruta1 • Yu Ohkura1 • 1 1 1 2 Aya Mizuno • Masaki Ueno • Harushi Udagawa • Yoshiharu Sakai Published online: 3 May 2016 ´ ´ Societe Internationale de Chirurgie 2016 Abstract Background Postoperative pancreatic fistula (POPF)—often caused by pancreatic injury during dissection of the peripancreatic lymph nodes—is a serious complication after gastric cancer surgery. We defined protruding pancreatic tissue on the anterior side of the pancreas head as ‘‘process of the pancreas head’’ (PPH) and investigated whether PPH is a predictable risk factor for POPF after laparoscopic gastrectomy. Methods We reviewed 255 patients who underwent laparoscopic total or distal gastrectomy for gastric cancer. The perioperative outcomes of 142 patients operated in the study’s early phase were investigated to evaluate the risk factors for POPF. To evaluate whether preoperative identification of PPH by computed tomography (CT) and intraoperative prediction of pancreas head outline could reduce the risk of POPF, the outcomes of 113 patients operated in the late phase were assessed. Results Of the 142 early-phase patients, PPH was identified intraoperatively in 38 patients (26.8 %). A total of 13 patients (9.1 %) developed POPF [grade 2. PPH was identified as a risk factor for POPF (P \0.01). In early-phase patients with PPH, the POPF rate was 21.0 %; in the late phase, it decreased to 4.3 %. Further, the POPF rate in early-phase patients with BMI [25 and PPH was 42.6 %, decreasing