Incidence and risk factors for postoperative pancreatic fistula in 2089 patients treated by radical gastrectomy: A prospective multicenter cohort study in China

Jianzhang Wu; Zhaoqing Tang; Gang Zhao; Lu Zang; Ziyu Li; Weidong Zang; Zhengrong Li; Jianjun Qu; Su Yan; Chaohui Zheng; Gang Ji; Linghua Zhu; Yongliang Zhao; Jian Zhang; Hua Huang; Yingxue Hao; Lin Fan; Hongtao Xu; Yong Li; Li Yang; Wu Song; Jiaming Zhu; Wenbin Zhang; Minzhe Li; Xinyu Qin; Fenglin Liu

doi:10.1016/j.ijsu.2021.106219

Incidence and risk factors for postoperative pancreatic fistula in 2089 patients treated by radical gastrectomy: A prospective multicenter cohort study in China

Int J Surg. 2022 Feb:98:106219. doi: 10.1016/j.ijsu.2021.106219. Epub 2022 Jan 4.

Affiliation

¹ Zhongshan Hospital, Department of General Surgery, Fudan University, 180 Fenglin Rd, Shanghai, 200032, China Department of General Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200217, China Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China The First Ward of Department of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Beijing Institute for Cancer Research, Beijing, 100142, China Department of Gastrointestinal Oncology Surgery, Fujian Provincial Cancer Hospital, Fuzhou, 350011, China Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330000, China Department of Oncology Surgery, Weifang People' s Hospital, Weifang, 261000, Shandong Province, China Department of Gastrointestinal Oncology Surgery, The Affiliated Hospital of Qinghai University, Xining, 810001, China Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, China Department of Gastrointestinal Surgery, The First Affiliated Hospital of Air Force Medical University, Xi'an, 710032, China Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China Department of General Surgery, The First Hospital Affiliated to Army Medical University, Chongqing, 400038, China Department of Gastrointestinal Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China Department of Gastric Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032, China Department of Vascular Surgery, The First Hospital Affiliated to Army Medical University, Chongqing, 400038, China Department of General Surgery, The First Affiliated Hospital of Xi' an Jiaotong University, Xi'an, 710061, China Department of General Surgery, Lishui Municipal Central Hospital, Lishui, 323000, Zhejiang Province, China Department of General Surgery, Guangdong Provincial People's Hospital, Guangzhou, 510000, China Department of General Surgery, Jiangsu Province Hospital, Nanjing, 210029, China Department of Gastrointestinal Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, China Department of Gastrointestinal Surgery, The Second Hospital of Jilin University, Changchun, 130022, China Department of General Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, China Department of General Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100043, China.

PMID: 34990829
DOI: 10.1016/j.ijsu.2021.106219

Abstract

Objective: To determine the incidence of clinically relevant postoperative pancreatic fistula (CR-POPF) following radical gastrectomy and to identify independent risk factors of CR-POPF.

Background: CR-POPF and its sequelae are potential complications following radical gastrectomy. The reported incidence of CR-POPF was quite different across various regions, and no consensus was reached.

Methods: Between December 2017 to November 2018, patients who underwent radical gastrectomy from 22 centers across 13 regions in China were prospectively recruited. The primary endpoint was the occurrence of CR-POPF, defined by the International Study Group of Pancreatic Fistula (ISGPF) in 2016. Clinically relevant change and short-term outcomes were recorded to diagnose and grade the POPF. Multivariate regression analyses were performed to identify independent risk factors of clinically relevant postoperative pancreatic fistula (CR-POPF).

Results: A total of 2089 cases were analyzed. The incidence of biochemical leakage (BL) and CR-POPF were 19.6% and 1.1% respectively. All CR-POPF patients recovered well after appropriate treatment and no Grade C POPF were recorded. Logistic regression analysis showed pTNM III (OR, 2.940; 95% CI 1.180-7.325; P = 0.021) and LigaSure usage (OR, 6.618; 95% CI 1.847-23.707; P = 0.004) were independent risk factors of CR-POPF. LigaSure usage (OR, 4.817; 95% CI 1.184-19.598; P = 0.028), the drain amylase content (D-AMY) on postoperative day 3 (POD3) ≥5 times the upper limit of normal amylase (OR, 3.476; 95% CI 1.240-9.744; P = 0.018) and open surgery (OR, 2.463; 95% CI 1.003-6.050; P = 0.049) were independent predictors for identifying CR-POPF from BL.

Conclusion: In rich-experienced gastric cancer centers, there is high prevalence of BL secondary to radical gastrectomy without clinical impact. Fewer patients suffered Grade B POPF, and Grade C POPF was less common. The patients with pTNM III or LigaSure usage were prone to suffer CR-POPF. Surgery procedure, LigaSure usage combined with D-AMY measurement on POD3 are promising for early identification of CR-POPF.

Keywords: Gastric cancer; Postoperative pancreatic fistula; Radical gastrectomy.

Publication types

Multicenter Study

MeSH terms

Gastrectomy* / adverse effects
Humans
Incidence
Pancreatic Fistula* / epidemiology
Pancreatic Fistula* / etiology
Pancreatic Fistula* / surgery
Pancreaticoduodenectomy
Postoperative Complications / epidemiology
Postoperative Complications / etiology
Postoperative Complications / surgery
Prospective Studies
Retrospective Studies
Risk Factors