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Accumulation of Excess Visceral Fat Is a Risk Factor for Pancreatic Fistula Formation After Total Gastrectomy

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The effect of obesity on gastrectomy in patients with gastric cancer is controversial. The degree of abdominal fat increases the technical difficulty of abdominal surgery. This study examined the effect of visceral fat on total gastrectomy and risk factors associated with the formation of pancreatic fistula.

Methods

Between February 2001 and April 2007, 191 patients with gastric cancer underwent total gastrectomy. The visceral fat area (VFA) was calculated from computed tomography (CT) scans taken at the level of the umbilicus using FatScan Software. Patients were divided into high- (≥100 cm2, n = 52) and low-VFA groups (<100 cm2, n = 139), and also into high- (≥25 kg/m2, n = 47) and low-BMI groups (<25 kg/m2, n = 144).

Results

Blood loss and incidence of pancreatic fistula were significantly higher in the high- than low-VFA group. However, only blood loss was significantly different between the high- and low-BMI groups. VFA, blood loss, and splenectomy were identified as significant risk factors for pancreatic fistula formation on univariate analysis, and multivariate logistic regression analysis of these factors identified VFA (p = 0.0001) and splenectomy (p = 0.0014) as significant predictors of pancreatic fistula.

Conclusions

VFA is a better indicator for pancreatic fistula formation after total gastrectomy than is BMI. Lymph node dissection must be performed carefully, especially in patients with visceral fat accumulation during total gastrectomy with splenectomy.

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Authors and Affiliations

  1. Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan

    Koji Tanaka MD, Isao Miyashiro MD, Masahiko Yano MD, Kentaro Kishi MD, Masaaki Motoori MD, Yousuke Seki MD, Shingo Noura MD, Masayuki Ohue MD, Terumasa Yamada MD, Hiroaki Ohigashi MD & Osamu Ishikawa MD

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  1. Koji Tanaka MD
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  2. Isao Miyashiro MD
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  3. Masahiko Yano MD
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  4. Kentaro Kishi MD
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  5. Masaaki Motoori MD
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  6. Yousuke Seki MD
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  7. Shingo Noura MD
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  8. Masayuki Ohue MD
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  9. Terumasa Yamada MD
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  10. Hiroaki Ohigashi MD
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  11. Osamu Ishikawa MD
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Corresponding author

Correspondence to Koji Tanaka MD.

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Tanaka, K., Miyashiro, I., Yano, M. et al. Accumulation of Excess Visceral Fat Is a Risk Factor for Pancreatic Fistula Formation After Total Gastrectomy. Ann Surg Oncol 16, 1520–1525 (2009). https://doi.org/10.1245/s10434-009-0391-y

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  • DOI: https://doi.org/10.1245/s10434-009-0391-y

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