Department of Gastric Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
Dig Surg. 2017;34(6):455-461. doi: 10.1159/000455332. Epub 2017 Feb 15.
We suspected that fatty pancreas, accompanied with metabolic syndrome, may be associated with the incidence of postoperative pancreatic fistula (POPF) after radial gastrectomy.
Between February 2012 and March 2014, we reviewed consecutive 79 gastric cancer patients who underwent radical gastrectomy. To quantify the degree of fatty infiltration to pancreas by preoperative contrast-enhanced CT, we measured ratios and differences between pancreatic and splenic attenuation values (P/S and P-S, respectively). The optimal cut-off values of P/S and P-S for predicting POPF were determined using the receiver operating characteristic (ROC) curve analysis. Risk factors for POPF of International Study Group on Pancreatic Fistula grade B or higher were examined using univariate and multivariate analyses.
POPF occurred in 6 patients (7.6%). ROC curve analyses revealed that the most optimal predictive values of P/S and P-S were 0.74 and -28.8, respectively. Univariate analysis demonstrated that high visceral fat area (p = 0.037), low P/S (p = 0.013), and low P-S (p = 0.006) were significant risk factors of POPF. Multivariate analysis demonstrated that low P/S (OR 10.2 [p = 0.046]) and low P-S (OR 13.2 [p = 0.023]) were significant risk factors of POPF.
Fatty pancreas is a risk factor of POPF after radical gastrectomy.
我们怀疑伴有代谢综合征的胰腺脂肪浸润与经桡动脉胃切除术（radial gastrectomy）后发生术后胰瘘（POPF）的风险有关。
2012 年 2 月至 2014 年 3 月，我们回顾性分析了 79 例行根治性胃切除术的胃癌患者的临床资料。为了定量评估术前增强 CT 胰腺脂肪浸润程度，我们测量了胰腺和脾脏衰减值之间的比值（P/S）和差值（P-S）。采用受试者工作特征（ROC）曲线分析确定预测 POPF 的最佳 P/S 和 P-S 截断值。采用单因素和多因素分析方法，探讨了国际胰腺瘘研究组（ISGPF）B 级或更高等级 POPF 的危险因素。
6 例（7.6%）患者发生 POPF。ROC 曲线分析显示，P/S 和 P-S 的最佳预测值分别为 0.74 和-28.8。单因素分析显示，高内脏脂肪面积（p=0.037）、低 P/S（p=0.013）和低 P-S（p=0.006）是 POPF 的显著危险因素。多因素分析显示，低 P/S（OR 10.2 [p=0.046]）和低 P-S（OR 13.2 [p=0.023]）是 POPF 的显著危险因素。
胰腺脂肪浸润是根治性胃切除术后发生 POPF 的危险因素。
