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Surgical Endoscopy
Published in: Surgical Endoscopy 9/2018

01-09-2018

Impact of anatomical position of the pancreas on postoperative complications and drain amylase concentrations after laparoscopic distal gastrectomy for gastric cancer

Authors: Koshi Kumagai, Naoki Hiki, Souya Nunobe, Satoshi Kamiya, Masahiro Tsujiura, Satoshi Ida, Manabu Ohashi, Toshiharu Yamaguchi, Takeshi Sano

Published in: Surgical Endoscopy | Issue 9/2018

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Abstract

Background

Laparoscopic surgery for gastric cancer requires traction or compression of the pancreas, with the extent depending on the anatomical position of the pancreas. This study investigated the impact of the position of the pancreas on postoperative complications and drain amylase concentrations after laparoscopic distal gastrectomy (LDG).

Methods

Gastric cancer patients who underwent LDG were assessed retrospectively. The following anatomical parameters were measured retrospectively in preoperative computed tomography sagittal projections: the length of the vertical line between the pancreas and the aorta (P–A length), representing the height of the slope looking down the celiac artery from the top of the pancreas, and the angle between a line drawn from the upper border of the pancreas to the root of the celiac artery and the aorta (UP–CA angle), representing the steepness of the slope. Correlations between each parameter and postoperative complications were analyzed by logistic regression analysis. Pearson’s product–moment correlation coefficients were calculated for scatter diagrams for each parameter and drain amylase concentration on postoperative day 1.

Results

Analyses were performed in 394 patients. P–A length [odds ratio (OR) 1.905; 95% confidence interval (CI) 1.100–3.300; P = 0.021] was significantly correlated with pancreatic fistula. P–A length (OR 2.771; 95% CI 1.506–5.098; P = 0.001), UP–CA angle (OR 2.323; 95% CI 1.251–4.314; P = 0.008), and low preoperative serum albumin (OR 2.082; 95% CI 1.050–4.128; P = 0.036) were significantly correlated with overall postoperative complications defined as Clavien–Dindo ≥ grade II. P–A length and UP–CA angle showed significant positive correlations with drain amylase concentration on postoperative day 1.

Conclusion

The position of the pancreas is an independent predictor of pancreatic fistula and/or postoperative complications and correlates with drain amylase concentration after LDG for gastric cancer.
Literature
1.
Adachi Y, Shiraishi N, Shiromizu A, Bandoh T, Aramaki M, Kitano S (2000) Laparoscopy-assisted Billroth I gastrectomy compared with conventional open gastrectomy. Arch Surg 135:806–810CrossRefPubMed
2.
Adachi Y, Suematsu T, Shiraishi N, Katsuta T, Morimoto A, Kitano S, Akazawa K (1999) Quality of life after laparoscopy-assisted Billroth I gastrectomy. Ann Surg 229:49–54CrossRefPubMedPubMedCentral
3.
Hayashi H, Ochiai T, Shimada H, Gunji Y (2005) Prospective randomized study of open versus laparoscopy-assisted distal gastrectomy with extraperigastric lymph node dissection for early gastric cancer. Surg Endosc 19:1172–1176CrossRefPubMed
4.
Huscher CG, Mingoli A, Sgarzini G, Sansonetti A, Di PM, Recher A, Ponzano C (2005) Laparoscopic versus open subtotal gastrectomy for distal gastric cancer: five-year results of a randomized prospective trial. Ann Surg 241:232–237CrossRefPubMedPubMedCentral
5.
Kim MC, Kim KH, Kim HH, Jung GJ (2005) Comparison of laparoscopy-assisted by conventional open distal gastrectomy and extraperigastric lymph node dissection in early gastric cancer. J Surg Oncol 91:90–94CrossRefPubMed
6.
Miura S, Kodera Y, Fujiwara M, Ito S, Mochizuki Y, Yamamura Y, Hibi K, Ito K, Akiyama S, Nakao A (2004) Laparoscopy-assisted distal gastrectomy with systemic lymph node dissection: a critical reappraisal from the viewpoint of lymph node retrieval. J Am Coll Surg 198:933–938CrossRefPubMed
7.
Mochiki E, Nakabayashi T, Kamimura H, Haga N, Asao T, Kuwano H (2002) Gastrointestinal recovery and outcome after laparoscopy-assisted versus conventional open distal gastrectomy for early gastric cancer. World J Surg 26:1145–1149CrossRefPubMed
8.
Mochiki E, Kamiyama Y, Aihara R, Nakabayashi T, Asao T, Kuwano H (2005) Laparoscopic assisted distal gastrectomy for early gastric cancer: five years’ experience. Surgery 137:317–322CrossRefPubMed
9.
Noshiro H, Nagai E, Shimizu S, Uchiyama A, Tanaka M (2005) Laparoscopically assisted distal gastrectomy with standard radical lymph node dissection for gastric cancer. Surg Endosc 19:1592–1596CrossRefPubMed
10.
Obama K, Okabe H, Hosogi H, Tanaka E, Itami A, Sakai Y (2011) Feasibility of laparoscopic gastrectomy with radical lymph node dissection for gastric cancer: from a viewpoint of pancreas-related complications. Surgery 149:15–21CrossRefPubMed
11.
Fujita T, Ohta M, Ozaki Y, Takahashi Y, Miyazaki S, Harada T, Iino I, Kikuchi H, Hiramatsu Y, Kamiya K, Konno H (2015) Collateral thermal damage to the pancreas by ultrasonic instruments during lymph node dissection in laparoscopic gastrectomy. Asian J Endosc Surg 8:281–288CrossRefPubMed
12.
Irino T, Hiki N, Ohashi M, Nunobe S, Sano T, Yamaguchi T (2016) The Hit and Away technique: optimal usage of the ultrasonic scalpel in laparoscopic gastrectomy. Surg Endosc 30:245–250CrossRefPubMed
13.
Kobayashi N, Shinohara H, Haruta S, Ohkura Y, Mizuno A, Ueno M, Udagawa H, Sakai Y (2016) Process of pancreas head as a risk factor for postoperative pancreatic fistula in laparoscopic gastric cancer surgery. World J Surg 40:2194–2201CrossRefPubMed
14.
Migita K, Matsumoto S, Wakatsuki K, Ito M, Kunishige T, Nakade H, Nakatani M, Kitano M, Nakajima Y (2016) The anatomical location of the pancreas is associated with the incidence of pancreatic fistula after laparoscopic gastrectomy. Surg Endosc 30:5481–5489CrossRefPubMed
15.
De Sol A, Cirocchi R, Di Patrizi MS, Boccolini A, Barillaro I, Cacurri A, Grassi V, Corsi A, Renzi C, Giuliani D, Coccetta M, Avenia N (2015) The measurement of amylase in drain fluid for the detection of pancreatic fistula after gastric cancer surgery: an interim analysis. World J Surg Oncol 13:65-CrossRefPubMedPubMedCentral
16.
Iwata N, Kodera Y, Eguchi T, Ohashi N, Nakayama G, Koike M, Fujiwara M, Nakao A (2010) Amylase concentration of the drainage fluid as a risk factor for intra-abdominal abscess following gastrectomy for gastric cancer. World J Surg 34:1534–1539CrossRefPubMed
17.
Kanda M, Fujiwara M, Tanaka C, Kobayashi D, Iwata N, Mizuno A, Yamada S, Fujii T, Nakayama G, Sugimoto H, Koike M, Kodera Y (2016) Predictive value of drain amylase content for peripancreatic inflammatory fluid collections after laparoscopic (assisted) distal gastrectomy. Surg Endosc 30:4353–4362CrossRefPubMed
18.
Kobayashi D, Iwata N, Tanaka C, Kanda M, Yamada S, Nakayama G, Fujii T, Koike M, Fujiwara M, Kodera Y (2015) Factors related to occurrence and aggravation of pancreatic fistula after radical gastrectomy for gastric cancer. J Surg Oncol 112:381–386CrossRefPubMed
19.
Miki Y, Tokunaga M, Bando E, Tanizawa Y, Kawamura T, Terashima M (2011) Evaluation of postoperative pancreatic fistula after total gastrectomy with D2 lymphadenectomy by ISGPF classification. J Gastrointest Surg 15:1969–1976CrossRefPubMed
20.
Tomimaru Y, Miyashiro I, Kishi K, Motoori M, Yano M, Shingai T, Noura S, Ohue M, Ohigashi H, Ishikawa O (2011) Is routine measurement of amylase concentration in drainage fluid necessary after total gastrectomy for gastric cancer? J Surg Oncol 104:274–277CrossRefPubMed
21.
Japanese Gastric Cancer Association (2017) Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer 20:1–19CrossRef
22.
Hiki N, Fukunaga T, Yamaguchi T, Nunobe S, Tokunaga M, Ohyama S, Seto Y, Yoshiba H, Nohara K, Inoue H, Muto T (2008) The benefits of standardizing the operative procedure for the assistant in laparoscopy-assisted gastrectomy for gastric cancer. Langenbecks Arch Surg 393:963–971CrossRefPubMed
23.
Kumagai K, Hiki N, Nunobe S, Jiang X, Kubota T, Aikou S, Watanabe R, Tanimura S, Sano T, Kitagawa Y, Yamaguchi T (2011) Different features of complications with Billroth-I and Roux-en-Y reconstruction after laparoscopy-assisted distal gastrectomy. J Gastrointest Surg 15:2145–2152CrossRefPubMed
24.
Kanaya S, Gomi T, Momoi H, Tamaki N, Isobe H, Katayama T, Wada Y, Ohtoshi M (2002) Delta-shaped anastomosis in totally laparoscopic Billroth I gastrectomy: new technique of intraabdominal gastroduodenostomy. J Am Coll Surg 195:284–287CrossRefPubMed
25.
Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de SE, Pekolj, Slankamenac J, Bassi K, Graf C, Vonlanthen R, Padbury R, Cameron R, Makuuchi JL M (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196CrossRefPubMed
26.
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefPubMedPubMedCentral
27.
Katayama H, Kurokawa Y, Nakamura K, Ito H, Kanemitsu Y, Masuda N, Tsubosa Y, Satoh T, Yokomizo A, Fukuda H, Sasako M (2016) Extended Clavien-Dindo classification of surgical complications: Japan Clinical Oncology Group postoperative complications criteria. Surg Today 46:668–685CrossRefPubMed
28.
Kodera Y, Sasako M, Yamamoto S, Sano T, Nashimoto A, Kurita A (2005) Identification of risk factors for the development of complications following extended and superextended lymphadenectomies for gastric cancer. Br J Surg 92:1103–1109CrossRefPubMed
29.
Jiang X, Hiki N, Nunobe S, Fukunaga T, Kumagai K, Nohara K, Sano T, Yamaguchi T (2011) Postoperative outcomes and complications after laparoscopy-assisted pylorus-preserving gastrectomy for early gastric cancer. Ann Surg 253:928–933CrossRefPubMed
30.
Tsujiura M, Hiki N, Ohashi M, Nunobe S, Kumagai K, Ida S, Okumura Y, Sano T, Yamaguchi T (2017) “Pancreas-compressionless gastrectomy”: a novel laparoscopic approach for suprapancreatic lymph node dissection. Ann Surg Oncol 24:3331–3337CrossRefPubMed
Metadata
Title
Impact of anatomical position of the pancreas on postoperative complications and drain amylase concentrations after laparoscopic distal gastrectomy for gastric cancer
Authors
Koshi Kumagai
Naoki Hiki
Souya Nunobe
Satoshi Kamiya
Masahiro Tsujiura
Satoshi Ida
Manabu Ohashi
Toshiharu Yamaguchi
Takeshi Sano
Publication date
01-09-2018
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 9/2018
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-018-6114-3

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