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Upper abdominal body shape is the risk factor for postoperative pancreatic fistula after splenectomy for advanced gastric cancer: a retrospective study.

Yamamoto N, Oshima T, Sato T, Makino H, Nagano Y, Fujii S, Rino Y, Imada T, Kunisaki C - World J Surg Oncol (2008)

Bottom Line: POPF occurred in 7 patients (14.0%) and was associated with a higher BMI, longer CAD, and higher CA depth ratio.However, CATD, U-APD, and U-TD did not differ significantly between patients with and those without POPF.BMI and body shape can predict the risk of POPF simply by CT.

View Article: PubMed Central - HTML - PubMed

Affiliation: Yokohama City University Medical Center, Gastroenterological Surgery, Yokohama, Japan. naoto-y@urahp.yokohama-cu.ac.jp

ABSTRACT

Background: Postoperative pancreas fistula (POPF) is a major complication after total gastrectomy with splenectomy. We retrospectively studied the effects of upper abdominal shape on the development of POPF after gastrectomy.

Methods: Fifty patients who underwent total gastrectomy with splenectomy were studied. The maximum vertical distance measured by computed tomography (CT) between the anterior abdominal skin and the back skin (U-APD) and the maximum horizontal distance of a plane at a right angle to U-APD (U-TD) were measured at the umbilicus. The distance between the anterior abdominal skin and the root of the celiac artery (CAD) and the distance of a horizontal plane at a right angle to CAD (CATD) were measured at the root of the celiac artery. The CA depth ratio (CAD/CATD) was calculated.

Results: POPF occurred in 7 patients (14.0%) and was associated with a higher BMI, longer CAD, and higher CA depth ratio. However, CATD, U-APD, and U-TD did not differ significantly between patients with and those without POPF. Logistic-regression analysis revealed that a high BMI (>or=25) and a high CA depth ratio (>or=0.370) independently predicted the occurrence of POPF (odds ratio = 19.007, p = 0.002; odds ratio = 13.656, p = 0.038, respectively).

Conclusion: Surgical procedures such as total gastrectomy with splenectomy should be very carefully executed in obese patients or patients with a deep abdominal cavity to decrease the risk of postoperative pancreatic fistula. BMI and body shape can predict the risk of POPF simply by CT.

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Related in: MedlinePlus

Measurement of body shape. Figures 1a and 1b represent the same patient's images who suffered POPF: a 73-year-old male (gastric cancer), 165 cm, 73 kg, BMI 26.8 kg/m2, CAD 13.1 cm, CATD 32.2 cm, CA-depth ratio 0.407, U-APD 20.0 cm, U-TD 29.0 cm.
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Figure 1: Measurement of body shape. Figures 1a and 1b represent the same patient's images who suffered POPF: a 73-year-old male (gastric cancer), 165 cm, 73 kg, BMI 26.8 kg/m2, CAD 13.1 cm, CATD 32.2 cm, CA-depth ratio 0.407, U-APD 20.0 cm, U-TD 29.0 cm.

Mentions: All CT were obtained with patients in a supine position, using a helical CT scanner within 2 months before gastrectomy. The distance between the anterior abdominal skin and the root of celiac artery was defined as CAD. The distance of a horizontal plane at a right angle to CAD was defined as CATD. CAD and CATD were measured on CT at the level of the root of the celiac artery (Figure. 1a). We then calculated the CA depth ratio (CAD/CATD) to more morphologically describe body shape. The maximum vertical distance between the anterior abdominal skin and the back skin was defined as U-APD. The maximum horizontal distance of a plane at a right angle to U-APD was defined as U-TD. U-APD and U-TD were measured on CT scans at the level of the umbilicus (Figure. 1b).


Upper abdominal body shape is the risk factor for postoperative pancreatic fistula after splenectomy for advanced gastric cancer: a retrospective study.

Yamamoto N, Oshima T, Sato T, Makino H, Nagano Y, Fujii S, Rino Y, Imada T, Kunisaki C - World J Surg Oncol (2008)

Measurement of body shape. Figures 1a and 1b represent the same patient's images who suffered POPF: a 73-year-old male (gastric cancer), 165 cm, 73 kg, BMI 26.8 kg/m2, CAD 13.1 cm, CATD 32.2 cm, CA-depth ratio 0.407, U-APD 20.0 cm, U-TD 29.0 cm.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2572060&req=5

Figure 1: Measurement of body shape. Figures 1a and 1b represent the same patient's images who suffered POPF: a 73-year-old male (gastric cancer), 165 cm, 73 kg, BMI 26.8 kg/m2, CAD 13.1 cm, CATD 32.2 cm, CA-depth ratio 0.407, U-APD 20.0 cm, U-TD 29.0 cm.
Mentions: All CT were obtained with patients in a supine position, using a helical CT scanner within 2 months before gastrectomy. The distance between the anterior abdominal skin and the root of celiac artery was defined as CAD. The distance of a horizontal plane at a right angle to CAD was defined as CATD. CAD and CATD were measured on CT at the level of the root of the celiac artery (Figure. 1a). We then calculated the CA depth ratio (CAD/CATD) to more morphologically describe body shape. The maximum vertical distance between the anterior abdominal skin and the back skin was defined as U-APD. The maximum horizontal distance of a plane at a right angle to U-APD was defined as U-TD. U-APD and U-TD were measured on CT scans at the level of the umbilicus (Figure. 1b).

Bottom Line: POPF occurred in 7 patients (14.0%) and was associated with a higher BMI, longer CAD, and higher CA depth ratio.However, CATD, U-APD, and U-TD did not differ significantly between patients with and those without POPF.BMI and body shape can predict the risk of POPF simply by CT.

View Article: PubMed Central - HTML - PubMed

Affiliation: Yokohama City University Medical Center, Gastroenterological Surgery, Yokohama, Japan. naoto-y@urahp.yokohama-cu.ac.jp

ABSTRACT

Background: Postoperative pancreas fistula (POPF) is a major complication after total gastrectomy with splenectomy. We retrospectively studied the effects of upper abdominal shape on the development of POPF after gastrectomy.

Methods: Fifty patients who underwent total gastrectomy with splenectomy were studied. The maximum vertical distance measured by computed tomography (CT) between the anterior abdominal skin and the back skin (U-APD) and the maximum horizontal distance of a plane at a right angle to U-APD (U-TD) were measured at the umbilicus. The distance between the anterior abdominal skin and the root of the celiac artery (CAD) and the distance of a horizontal plane at a right angle to CAD (CATD) were measured at the root of the celiac artery. The CA depth ratio (CAD/CATD) was calculated.

Results: POPF occurred in 7 patients (14.0%) and was associated with a higher BMI, longer CAD, and higher CA depth ratio. However, CATD, U-APD, and U-TD did not differ significantly between patients with and those without POPF. Logistic-regression analysis revealed that a high BMI (>or=25) and a high CA depth ratio (>or=0.370) independently predicted the occurrence of POPF (odds ratio = 19.007, p = 0.002; odds ratio = 13.656, p = 0.038, respectively).

Conclusion: Surgical procedures such as total gastrectomy with splenectomy should be very carefully executed in obese patients or patients with a deep abdominal cavity to decrease the risk of postoperative pancreatic fistula. BMI and body shape can predict the risk of POPF simply by CT.

Show MeSH
Related in: MedlinePlus