Predictive factors for pancreatic fistula after pancreaticosplenectomy for advanced gastric cancer in the upper third of the stomach.

This study aimed to retrospectively investigate the predictive factors for pancreatic fistula following pancreaticosplenectomy. Pancreatic fistula is a major lethal complication of pancreaticosplenectomy. However, predictive factors for this condition have not yet been established. Between April 1992 and March 2000, 147 patients with advanced gastric cancer that was located predominantly in the upper third of the stomach were enrolled in this study. Predictive factors for pancreatic fistula were investigated using univariate and multivariate analyses. Pancreatic fistula, as defined according to our criteria, was observed in 73 (49.7%) patients. In the univariate analysis, age, body mass index, serum zinc level, hyperlipidemia, and comorbid disease all significantly affected the incidence of pancreatic fistula. In the multivariate analysis, body mass index, hyperlipidemia, and comorbid disease independently predicted the occurrence of pancreatic fistula. By contrast, the experience of the operating surgeon had no significant effect on the frequency of this condition. Our results suggest that pancreaticosplenectomy, the surgical merit of which is not apparent, should be avoided whenever possible. If this operative procedure must be used (e.g., in patients with extensive tumor presence), careful manipulation and appropriate drainage are essential, particularly in cases showing predictive factors of pancreatic fistula.