Risk Factors for Pancreas-related Abscess After Total Gastrectomy

Background: European clinical trials of gastrectomy have shown that pancreas-related complications are the major cause of mortality. The aim of this study was to determine the risk factors for pancreas-related abscess after gastrectomy and to evaluate the effects of the abscess on postoperative mortality.

Methods: Between 1992 and 1999, 663 consecutive patients with gastric carcinoma underwent total gastrectomy. Data from these patients were analyzed, to identify the predictors of pancreas-related abscess caused by pancreatic juice leakage, by a multiple logistic regression model.

Results: On multivariate analysis, increasing age (P = 0.018) and body mass index (P = 0.006) were independent preoperative risk factors. Dissection along the distal splenic artery was an intraoperative risk factor. The hazard ratios were increased 9.13-fold (P = 0.000) with a pancreas-preserving operation and 16.72-fold (P = 0.000) by distal pancreatectomy. Patients with the abscess had a higher postoperative mortality rate (P = 0.008), and a higher re-operation rate (P < 0.001) than patients without the abscess.

Conclusion: Pancreas-related abscess is more likely to occur in older, obese patients undergoing node dissection along the distal splenic artery. Abscess formation is associated with a higher mortality and re-operation rate. Spleen preservation should be evaluated in Japan.