Factors Related to Occurrence and Aggravation of Pancreatic Fistula After Radical Gastrectomy for Gastric Cancer

Background and Objectives: Pancreatic fistula (PF) and subsequent intra-abdominal abscess is a serious complication after gastrectomy for gastric cancer. The study aims to evaluate amylase concentration of drainage fluid (d-AMY) and serum C-reactive protein (CRP) as the predictive factors related to PF amounting to Clavien-Dindo (CD) grade III. Methods: 448 patients who underwent gastrectomy for gastric cancer were analyzed. Closed drains were placed in the left subphrenic cavity and/or Winslow's cavity depending on the procedures. The cutoff values of d-AMY and CRP were determined, and their roles as predictive factors for CD grade III PF were evaluated. Results: PF, diagnosed in 58 patients, was stratified according to the CD classification. Consequently, grade III PF which includes PF-related abscesses was observed in 32 patients. The cutoff value of d-AMY on the first postoperative day for predicting grade III PF was 1949 IU/l. The cutoff value of CRP on the third postoperative day for the same purpose was 20.44 mg/dl. Multivariate analysis demonstrated that d-AMY and CRP were significant predictive factors for grade III PF. Conclusions: The d-AMY on the first postoperative day and CRP on the third postoperative day might be useful for predicting CD grade III PF after gastrectomy. (c) 2015 Wiley Periodicals, Inc.