Evaluation of Postoperative Pancreatic Fistula After Total Gastrectomy with D2 Lymphadenectomy by ISGPF Classification

Postoperative pancreatic fistula (POPF) is a serious complication of total gastrectomy (TG) with D2 lymphadenectomy (D2). However, the actual incidence and risk factors are not yet completely understood, due in part to the absence of the widely accepted criteria for POPF following gastrectomy. One hundred and four patients who underwent TG with D2 between March 2007 and December 2009 were included in this study. The incidence and severity of POPF were evaluated according to the International Study Group on Pancreatic Fistula (ISGPF) classification. In addition, risk factors for POPF of ISGPF grade B or higher were investigated. POPFs of ISGPF grade B or higher were observed in 23 patients (22.1%). Univariate analysis found that sex, body mass index, and amylase concentration of drainage fluid (d-AMY) on the first postoperative day (1POD) were significant predictors of POPF grade B or higher. The appropriate cutoff level of d-AMY on 1POD was calculated as 3398 IU/l. Multivariate analysis showed that d-AMY a parts per thousand yen3,398 IU/l on 1POD was the only independent risk factor. High d-AMY on 1POD (a parts per thousand yen3,398 IU/l) can predict a grade B or higher POPF, and this value may be useful in the early detection of POPF following TG with D2.