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Erschienen in: Gastric Cancer 2/2012

01.04.2012 | Original article

Intra-abdominal infectious complications following gastrectomy in patients with excessive visceral fat

verfasst von: Norihiko Sugisawa, Masanori Tokunaga, Yutaka Tanizawa, Etsuro Bando, Taiichi Kawamura, Masanori Terashima

Erschienen in: Gastric Cancer | Ausgabe 2/2012

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Abstract

Background

Excessive visceral fat may be a better predictor of the development of postoperative morbidity after gastrectomy than body mass index (BMI). The aim of the present study was to clarify the most appropriate fat parameter to predict pancreas-related infection and anastomotic leakage following gastrectomy.

Methods

The study was performed in 206 patients who underwent curative gastrectomy at the Shizuoka Cancer Center between April 2008 and March 2009. Relationships between fat parameters, including visceral fat area (VFA), and early surgical outcomes were investigated. The risk factors for pancreas-related infection and anastomotic leakage were identified using univariate and multivariate analyses.

Results

There was no strong association between any of the fat parameters and operating time, intraoperative blood loss, the number of lymph nodes retrieved, or the duration of the postoperative hospital stay. Pancreas-related infection occurred in 18 patients (8.7%), whereas anastomotic leakage was observed in 10 patients (4.9%). Of all the fat parameters, only VFA was found to be an independent risk factor for both pancreas-related infection and anastomotic leakage, with odds ratios (95% confidence intervals) of 1.015 (1.005–1.025) and 1.010 (1.000–1.021), respectively.

Conclusions

Excessive visceral fat, represented by the VFA, was found to be an independent risk factor for both pancreas-related infection and anastomotic leakage following gastrectomy.
Literatur
1.
Zurück zum Zitat Maruyama K, Okabayashi K, Kinoshita T. Progress in gastric cancer surgery in Japan and its limits of radicality. World J Surg. 1987;11:418–25.PubMedCrossRef Maruyama K, Okabayashi K, Kinoshita T. Progress in gastric cancer surgery in Japan and its limits of radicality. World J Surg. 1987;11:418–25.PubMedCrossRef
2.
Zurück zum Zitat Sasako M, McCulloch P, Kinoshita T, Maruyama K. New method to evaluate the therapeutic value of lymph node dissection for advanced gastric cancer. Br J Surg. 1995;82:346–51.PubMedCrossRef Sasako M, McCulloch P, Kinoshita T, Maruyama K. New method to evaluate the therapeutic value of lymph node dissection for advanced gastric cancer. Br J Surg. 1995;82:346–51.PubMedCrossRef
3.
Zurück zum Zitat Bonenkamp JJ, Songun I, Hermans J, Sasako M, Welvaart K, Plukker JTM, et al. Randomised comparison of morbidity after D1 and D2 dissection for gastric cancer in 996 Dutch patients. Lancet. 1995;2345:745–8.CrossRef Bonenkamp JJ, Songun I, Hermans J, Sasako M, Welvaart K, Plukker JTM, et al. Randomised comparison of morbidity after D1 and D2 dissection for gastric cancer in 996 Dutch patients. Lancet. 1995;2345:745–8.CrossRef
4.
Zurück zum Zitat Cuschieri A, Fayers P, Fielding J, Craven J, Bancewicz J, Joypaul V, et al. Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomised controlled surgical trial. Lancet. 1996;347:995–9.PubMedCrossRef Cuschieri A, Fayers P, Fielding J, Craven J, Bancewicz J, Joypaul V, et al. Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomised controlled surgical trial. Lancet. 1996;347:995–9.PubMedCrossRef
5.
Zurück zum Zitat Bonekamp JJ, Hermans J, Sasako M, van de Velde CJH. Extend lymph-node dissection for gastric cancer. N Engl J Med. 1999;340:908–14.CrossRef Bonekamp JJ, Hermans J, Sasako M, van de Velde CJH. Extend lymph-node dissection for gastric cancer. N Engl J Med. 1999;340:908–14.CrossRef
6.
Zurück zum Zitat Cuschieri A, Weeden S, Fielding J, Bancewicz J, Craven J, Joypaul V, et al. Patient survival after D1 and D2 resections for gastric cancer: long-term results of the MRC randomized surgical trial. Surgical Co-operative Group. Br J Cancer. 1999;79:1522–30.PubMedCrossRef Cuschieri A, Weeden S, Fielding J, Bancewicz J, Craven J, Joypaul V, et al. Patient survival after D1 and D2 resections for gastric cancer: long-term results of the MRC randomized surgical trial. Surgical Co-operative Group. Br J Cancer. 1999;79:1522–30.PubMedCrossRef
7.
Zurück zum Zitat Kubo M, Sano T, Fukagawa T, Katai H, Sasako M. Increasing body mass index in Japanese patients with gastric cancer. Gastric Cancer. 2005;8:39–41.PubMedCrossRef Kubo M, Sano T, Fukagawa T, Katai H, Sasako M. Increasing body mass index in Japanese patients with gastric cancer. Gastric Cancer. 2005;8:39–41.PubMedCrossRef
8.
Zurück zum Zitat Inagawa S, Adachi S, Oda T, Kawamoto T, Koike N, Fukao K. Effect of fat volume on postoperative complications and survival rate after D2 dissection for gastric cancer. Gastric Cancer. 2000;3:141–4.PubMedCrossRef Inagawa S, Adachi S, Oda T, Kawamoto T, Koike N, Fukao K. Effect of fat volume on postoperative complications and survival rate after D2 dissection for gastric cancer. Gastric Cancer. 2000;3:141–4.PubMedCrossRef
9.
Zurück zum Zitat Tsujinaka T, Sasako M, Yamamoto S, Sano T, Kurokawa Y, Nashimoto A, et al. Influence of overweight on surgical complications for gastric cancer: results from a randomized control trial comparing D2 and extended paraaortic D3 lymphadenectomy (JCOG9501). Ann Surg Oncol. 2007;14:355–61.PubMedCrossRef Tsujinaka T, Sasako M, Yamamoto S, Sano T, Kurokawa Y, Nashimoto A, et al. Influence of overweight on surgical complications for gastric cancer: results from a randomized control trial comparing D2 and extended paraaortic D3 lymphadenectomy (JCOG9501). Ann Surg Oncol. 2007;14:355–61.PubMedCrossRef
10.
Zurück zum Zitat Ojima T, Iwahashi M, Nakamori M, Nakamura M, Naka T, Ishida K, et al. Influence of overweight on patients with gastric cancer after undergoing curative gastrectomy. Arch Surg. 2009;144(4):351–8.PubMedCrossRef Ojima T, Iwahashi M, Nakamori M, Nakamura M, Naka T, Ishida K, et al. Influence of overweight on patients with gastric cancer after undergoing curative gastrectomy. Arch Surg. 2009;144(4):351–8.PubMedCrossRef
11.
Zurück zum Zitat Gretschel S, Christoph F, Bembenek A, Estevez-Schwarz L, Schneider U, Schlag PM. Body mass index does not affect systematic D2 lymph node dissection and postoperative morbidity in gastric cancer patients. Ann Surg Oncol. 2003;10:363–8.PubMedCrossRef Gretschel S, Christoph F, Bembenek A, Estevez-Schwarz L, Schneider U, Schlag PM. Body mass index does not affect systematic D2 lymph node dissection and postoperative morbidity in gastric cancer patients. Ann Surg Oncol. 2003;10:363–8.PubMedCrossRef
12.
Zurück zum Zitat Lee JH, Paik YH, Lee JS, Ryu KW, Kim CG, Park SR, et al. Abdominal shape of gastric cancer patients influences short-term surgical outcomes. Ann Surg Oncol. 2007;14:1288–94.PubMedCrossRef Lee JH, Paik YH, Lee JS, Ryu KW, Kim CG, Park SR, et al. Abdominal shape of gastric cancer patients influences short-term surgical outcomes. Ann Surg Oncol. 2007;14:1288–94.PubMedCrossRef
13.
Zurück zum Zitat Tokunaga M, Hiki N, Fukunaga T, Ogura T, Miyata S, Yamaguchi T. Effect of individual fat areas on early surgical outcomes after open gastrectomy for gastric cancer. Br J Surg. 2009;96:496–500.PubMedCrossRef Tokunaga M, Hiki N, Fukunaga T, Ogura T, Miyata S, Yamaguchi T. Effect of individual fat areas on early surgical outcomes after open gastrectomy for gastric cancer. Br J Surg. 2009;96:496–500.PubMedCrossRef
14.
Zurück zum Zitat Tanaka K, Miyashiro I, Yano M, Kishi K, Motoori M, Seki Y, et al. Accumulation of excess visceral fat is a risk factor for pancreatic fistula formation after total gastrectomy. Ann Surg Oncol. 2009;16:1520–5.PubMedCrossRef Tanaka K, Miyashiro I, Yano M, Kishi K, Motoori M, Seki Y, et al. Accumulation of excess visceral fat is a risk factor for pancreatic fistula formation after total gastrectomy. Ann Surg Oncol. 2009;16:1520–5.PubMedCrossRef
15.
Zurück zum Zitat Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma—2nd English edition. Gastric Cancer. 1998;1:10–24.PubMedCrossRef Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma—2nd English edition. Gastric Cancer. 1998;1:10–24.PubMedCrossRef
16.
17.
Zurück zum Zitat Dindo D, Demartines N, Clavien PA. Classification of surgical complications. A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.PubMedCrossRef Dindo D, Demartines N, Clavien PA. Classification of surgical complications. A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.PubMedCrossRef
18.
Zurück zum Zitat Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005;138:8–13.PubMedCrossRef Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005;138:8–13.PubMedCrossRef
19.
Zurück zum Zitat Sano T, Sasako M, Yamamoto S, Nashimoto A, Kurita A, Hiratsuka M, et al. Gastric cancer surgery: morbidity and mortality results from a prospective randomized controlled trial comparing D2 and extended para-aortic lymphadenectomy—Japan Clinical Oncology Group Study 9501. J Clin Oncol. 2004;22:2767–73.PubMedCrossRef Sano T, Sasako M, Yamamoto S, Nashimoto A, Kurita A, Hiratsuka M, et al. Gastric cancer surgery: morbidity and mortality results from a prospective randomized controlled trial comparing D2 and extended para-aortic lymphadenectomy—Japan Clinical Oncology Group Study 9501. J Clin Oncol. 2004;22:2767–73.PubMedCrossRef
20.
Zurück zum Zitat Wu CW, Hsiung CA, Lo SS, Hsieh MC, Shia LT, Whang-Peng J. Randomized clinical trial of morbidity after D1 and D3 surgery for gastric cancer. Br J Surg. 2004;91:283–7.PubMedCrossRef Wu CW, Hsiung CA, Lo SS, Hsieh MC, Shia LT, Whang-Peng J. Randomized clinical trial of morbidity after D1 and D3 surgery for gastric cancer. Br J Surg. 2004;91:283–7.PubMedCrossRef
21.
Zurück zum Zitat de Manzoni G, Verlato G, Guglielmi A, Laterza E, Genna M, Cordiano C. Prognostic significance of lymph node dissection in gastric cancer. Br J Surg. 1996;83:1604–7.PubMedCrossRef de Manzoni G, Verlato G, Guglielmi A, Laterza E, Genna M, Cordiano C. Prognostic significance of lymph node dissection in gastric cancer. Br J Surg. 1996;83:1604–7.PubMedCrossRef
22.
Zurück zum Zitat Smith BR, Stabile BE. Aggressive D2 lymphadenectomy is required for accurate pathologic staging of gastric adenocarcinoma. Am Surg. 2006;72:849–52.PubMed Smith BR, Stabile BE. Aggressive D2 lymphadenectomy is required for accurate pathologic staging of gastric adenocarcinoma. Am Surg. 2006;72:849–52.PubMed
23.
Zurück zum Zitat Marrelli D, Pedrazzani C, Neri A, Corso G, DeStefano A, Pinto E, et al. Complications after extended (D2) and superextended (D3) lymphadenectomy for gastric cancer: analysis of potential risk factors. Ann Surg Oncol. 2007;14:25–33.PubMedCrossRef Marrelli D, Pedrazzani C, Neri A, Corso G, DeStefano A, Pinto E, et al. Complications after extended (D2) and superextended (D3) lymphadenectomy for gastric cancer: analysis of potential risk factors. Ann Surg Oncol. 2007;14:25–33.PubMedCrossRef
24.
Zurück zum Zitat Danielson H, Kokkola A, Kiviluoto T, Siren J, Luohimo J, Kivilaakso E, et al. Clinical outcome after D1 vs D2–3 gastrectomy for treatment of gastric cancer. Scand J Surg. 2007;96:35–40.PubMed Danielson H, Kokkola A, Kiviluoto T, Siren J, Luohimo J, Kivilaakso E, et al. Clinical outcome after D1 vs D2–3 gastrectomy for treatment of gastric cancer. Scand J Surg. 2007;96:35–40.PubMed
25.
Zurück zum Zitat Degiuli M, Sasako M, Ponti A, Calvo F. Survival results of a multicentre phase II study to evaluate D2 gastrectomy for gastric cancer. Br J Cancer. 2004;90:1727–32.PubMed Degiuli M, Sasako M, Ponti A, Calvo F. Survival results of a multicentre phase II study to evaluate D2 gastrectomy for gastric cancer. Br J Cancer. 2004;90:1727–32.PubMed
26.
Zurück zum Zitat Sierzega M, Kolodziejczyk J, Kulig J, Polish Gastric Cancer Study Group. Impact of anastomotic leakage on long-term survival after total gastrectomy for carcinoma of the stomach. Br J Surg. 2010;97:1035–42.PubMedCrossRef Sierzega M, Kolodziejczyk J, Kulig J, Polish Gastric Cancer Study Group. Impact of anastomotic leakage on long-term survival after total gastrectomy for carcinoma of the stomach. Br J Surg. 2010;97:1035–42.PubMedCrossRef
27.
Zurück zum Zitat Ser KH, Lee WJ, Lee YC, et al. Experience in laparoscopic sleeve gastrectomy for morbidly obese Taiwanese: staple-line reinforcement is important for preventing leakage. Surg Endosc. 2010;24:2253–9.PubMedCrossRef Ser KH, Lee WJ, Lee YC, et al. Experience in laparoscopic sleeve gastrectomy for morbidly obese Taiwanese: staple-line reinforcement is important for preventing leakage. Surg Endosc. 2010;24:2253–9.PubMedCrossRef
28.
Zurück zum Zitat Kang KC, Cho GS, Han SU, Kim W, Kim HH, Kim MC, et al. Comparison of Billroth I and Billroth II reconstructions after laparoscopy-assisted distal gastrectomy: a retrospective analysis of large-scale multicenter results from Korea. Surg Endosc. 2011;25:1953–61. Kang KC, Cho GS, Han SU, Kim W, Kim HH, Kim MC, et al. Comparison of Billroth I and Billroth II reconstructions after laparoscopy-assisted distal gastrectomy: a retrospective analysis of large-scale multicenter results from Korea. Surg Endosc. 2011;25:1953–61.
29.
Zurück zum Zitat Grotenhuis BA, Wijnhoven BPL, Hötte GJ, van der Stok EP, Tilanus HW, van Lanshot JJB, et al. Prognostic value of body mass index on short-term and long-term outcome after resection of esophageal cancer. World J Surg. 2010;34:2621–7.PubMedCrossRef Grotenhuis BA, Wijnhoven BPL, Hötte GJ, van der Stok EP, Tilanus HW, van Lanshot JJB, et al. Prognostic value of body mass index on short-term and long-term outcome after resection of esophageal cancer. World J Surg. 2010;34:2621–7.PubMedCrossRef
30.
Zurück zum Zitat Pi-Sunyer FX. Medical hazards of obesity. Ann Intern Med. 1993;119:655–60.PubMed Pi-Sunyer FX. Medical hazards of obesity. Ann Intern Med. 1993;119:655–60.PubMed
31.
32.
Zurück zum Zitat Songun I, Putter H, Kranenbarg EM, Sasako M, Van de Velde CJ. Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol. 2010;11:439–49.PubMedCrossRef Songun I, Putter H, Kranenbarg EM, Sasako M, Van de Velde CJ. Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol. 2010;11:439–49.PubMedCrossRef
33.
Zurück zum Zitat Sano T, Sasako M, Shibata T, Yamamoto S, Tsuburaya A, Nashimoto A, et al. Randomized controlled trial to evaluate splenectomy in total gastrectomy for proximal gastric carcinoma (JCOG0110): Analyses of operative morbidity, operation time, and blood loss. J Clin Oncol 2010;28:15s (suppl; abstr 4020). Sano T, Sasako M, Shibata T, Yamamoto S, Tsuburaya A, Nashimoto A, et al. Randomized controlled trial to evaluate splenectomy in total gastrectomy for proximal gastric carcinoma (JCOG0110): Analyses of operative morbidity, operation time, and blood loss. J Clin Oncol 2010;28:15s (suppl; abstr 4020).
34.
Zurück zum Zitat Katai H, Yoshimura K, Fukagawa T, Sano T, Sasako M. Risk factors for pancreas-related abscess after gastrectomy. Gastric Cancer. 2005;8:137–41.PubMedCrossRef Katai H, Yoshimura K, Fukagawa T, Sano T, Sasako M. Risk factors for pancreas-related abscess after gastrectomy. Gastric Cancer. 2005;8:137–41.PubMedCrossRef
35.
Zurück zum Zitat Nobuoka D, Gothda N, Konishi M, Nakagohri T, Takahashi S, Kinoshita T. Prevention of postoperative pancreatic fistula after total gastrectomy. World J Surg. 2008;32:2261–6.PubMedCrossRef Nobuoka D, Gothda N, Konishi M, Nakagohri T, Takahashi S, Kinoshita T. Prevention of postoperative pancreatic fistula after total gastrectomy. World J Surg. 2008;32:2261–6.PubMedCrossRef
Metadaten
Titel
Intra-abdominal infectious complications following gastrectomy in patients with excessive visceral fat
verfasst von
Norihiko Sugisawa
Masanori Tokunaga
Yutaka Tanizawa
Etsuro Bando
Taiichi Kawamura
Masanori Terashima
Publikationsdatum
01.04.2012
Verlag
Springer Japan
Erschienen in
Gastric Cancer / Ausgabe 2/2012
Print ISSN: 1436-3291
Elektronische ISSN: 1436-3305
DOI
https://doi.org/10.1007/s10120-011-0099-0

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