Martiniuc Alexandru, Dumitrascu Traian, Ionescu Mihnea, Tudor Stefan, Lacatus Monica, Herlea Vlad, Vasilescu Catalin
Department of General Surgery, Fundeni Clinical Institute, Bucharest, Romania.
Department of Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
J Gastric Cancer. 2021 Mar;21(1):16-29. doi: 10.5230/jgc.2021.21.e3. Epub 2021 Mar 18.
Incidence, risk factors, and clinical consequences of pancreatic fistula (POPF) after D1+/D2 radical gastrectomy have not been well investigated in Western patients, particularly those from Eastern Europe.
A total of 358 D1+/D2 radical gastrectomies were performed by surgeons with high caseloads in a single surgical center from 2002 to 2017. A retrospective analysis of data that were prospectively gathered in an electronic database was performed. POPF was defined and graded according to the International Study Group for Pancreatic Surgery (ISGPS) criteria. Uni- and multivariate analyses were performed to identify potential predictors of POPF. Additionally, the impact of POPF on early complications and long-term outcomes were investigated.
POPF was observed in 20 patients (5.6%), according to the updated ISGPS grading system. Cardiovascular comorbidities emerged as the single independent predictor of POPF formation (risk ratio, 3.051; 95% confidence interval, 1.161-8.019; P=0.024). POPF occurrence was associated with statistically significant increased rates of postoperative hemorrhage requiring re-laparotomy (P=0.029), anastomotic leak (P=0.002), 90-day mortality (P=0.036), and prolonged hospital stay (P<0.001). The long-term survival of patients with gastric adenocarcinoma was not affected by POPF (P=0.661).
In this large series of Eastern European patients, the clinically relevant rate of POPF after D1+/D2 radical gastrectomy was low. The presence of co-existing cardiovascular disease favored the occurrence of POPF and was associated with an increased risk of postoperative bleeding, anastomotic leak, 90-day mortality, and prolonged hospital stay. POPF was not found to affect the long-term survival of patients with gastric adenocarcinoma.
在西方患者，尤其是东欧患者中，D1+/D2根治性胃切除术后胰瘘（POPF）的发生率、危险因素及临床后果尚未得到充分研究。
2002年至2017年期间，在单一手术中心由高手术量的外科医生共实施了358例D1+/D2根治性胃切除术。对前瞻性收集于电子数据库中的数据进行回顾性分析。根据国际胰腺手术研究组（ISGPS）标准定义并分级POPF。进行单因素和多因素分析以确定POPF的潜在预测因素。此外，研究了POPF对早期并发症和长期结局的影响。
根据更新后的ISGPS分级系统，20例患者（5.6%）出现POPF。心血管合并症是POPF形成的唯一独立预测因素（风险比，3.051；95%置信区间，1.161 - 8.019；P = 0.024）。POPF的发生与需要再次开腹手术的术后出血发生率显著增加（P = 0.029）、吻合口漏（P = 0.
