Risk factors to predict severe postoperative pancreatic fistula following gastrectomy for gastric cancer

Table 1 Characteristics of 35 patients with postoperative pancreatic fistula following gastrectomy n (%)

Sex	Male	30 (86)
	Female	5 (14)
Age (yr)	mean + SD	67.3 ± 9.5
BMI (kg/m2)	mean + SD	22.1 ± 3.2
pT-stage	T1	3 (9)
	T2	11 (31)
	T3	15 (43)
	T4	6 (17)
pN-stage	N0	10 (29)
	N1	3 (9)
	N2	9 (26)
	N3	13 (36)
pStage	I	6 (17)
	II	3 (9)
	III	18 (51)
	IV	8 (23)
Gastrectomy	Distal	10 (29)
	Total or others1	25 (71)
Splenectomy	Presence	21 (60)
	Absence	14 (40)
Pancreaticosplenectomy	Presence	12 (34)
	Absence	23 (66)
Lymphadenectomy	< D2	8 (23)
	D2 ≤	27 (77)
Resection status	R0	10 (29)
	R1	15 (42)
	R2	10 (29)
ISGPF classification	Grade B	17 (49)
	Grade C	18 (51)

¹Others; proximal gastrectomy and remnant gastrectomy. ISGPF: International Study Group on Pancreatic Fistula; BMI: Body mass index.

Table 2 Comparison of clinicopathologic factors and International Study Group on Pancreatic Fistula classification in patients with severe postoperative pancreatic fistula between short and long duration of intensive treatments n (%)

Variables		Intensive treatment periods for POPF		1P value
		< 20 d	20 d ≤
Sex	Male	10 (83)	20 (87)
	Female	2 (17)	3 (13)	0.827
Age (yr)	< 65	5 (42)	7 (30)
	65 ≤	7 (58)	16 (70)	0.772
BMI (kg/m2)	< 21	5 (42)	6 (27)
	21 ≤	7 (58)	16 (73)	0.636
pT-stage	T1 T2	3 (25)	3 (13)
	T3 T4	9 (75)	20 (87)	0.391
pN-stage	N1 N2	5 (42)	16 (70)
	N3	7 (58)	7 (30)	0.217
pStage	III	4 (33)	5 (22)
	III IV	8 (67)	18 (78)	0.736
Splenectomy	Presence	7 (58)	14 (61)
	Absence	5 (42)	9 (39)	0.827
Pancreatico-splenectomy	Presence	2 (17)	10 (43)
	Absence	10 (83)	13 (57)	0.149
Lymphadenectomy	< D2	2 (17)	6 (26)
	D2 ≤	10 (83)	17 (74)	0.685
Resection status	R0	5 (42)	5 (22)
	R1	4 (33)	11 (48)
	R2	3 (25)	7 (30)	0.728
Blood loss (g)	< 1000	3 (25)	9 (39)
	1000 ≤	9 (75)	14 (61)	0.476
Operation time (min)	< 330	6 (50)	11 (48)
	330 ≤	6 (50)	12 (52)	0.815
Preoperative Hb (g/dL)	< 10	5 (42)	3 (13)
	10 ≤	7 (58)	20 (87)	0.091
Preoperative Alb (g/dL)	≤ 3.5	3 (30)	6 (29)
	3.5 <	7 (70)	15 (71)	1.000
2Lymphocyte counts (/mm3)	< 850	5 (42)	18 (78)
	850 ≤	7 (58)	5 (22)	0.073
ISGPF classification	grade B	9 (75)	8 (35)
	grade C	3 (25)	15 (65)	0.0353

¹P values were derived from the χ² or Fisher's exact test and were considered significant at < 0.05.

²Lymphocyte counts at the diagnosis of POPF;

³Significant values. ISGPF: International Study Group on Pancreatic Fistula; POPF: Postoperative pancreatic fistula; BMI: Body mass index.

Table 3 Comparison of clinical factors between grade B and C postoperative pancreatic fistula according to International Study Group on Pancreatic Fistula classification n (%)

Variables		Total	ISGPF classification		1P value
			Grade B (n = 17)	Grade C (n = 18)
Sex	Male	30	14 (82)	16 (89)
	Female	5	3 (18)	2 (11)	0.944
Age (yr)	< 65	12	9 (53)	3 (17)
	65 ≤	23	8 (47)	15 (83)	0.0353
BMI (kg/m2)	< 21	13	9 (53)	4 (24)
	21 ≤	21	8 (47)	13 (76)	0.158
pT-stage	T1 T2	6	4 (24)	2 (11)
	T3 T4	29	13 (76)	16 (89)	0.402
pN-stage	N1 N2	21	9 (53)	12 (67)
	N3	14	8 (47)	6 (33)	0.629
pStage	III	9	5 (29)	4 (22)
	III IV	26	12 (71)	14 (78)	0.921
Splenectomy	Presence	21	11 (65)	10 (56)
	Absence	14	6 (35)	8 (44)	0.836
Pancreaticosplenectomy	Presence	12	4 (24)	8 (44)
	Absence	23	13 (76)	10 (56)	0.344
Lymphadenectomy	< D2	8	3 (18)	5 (28)
	D2 ≤	27	14 (82)	13 (72)	0.691
Resection status	R0	10	4 (24)	6 (33)
	R1	15	7(41)	8 (45)
	R2	10	6 (35)	4 (22)	0.892
Blood loss (g)	< 1000	23	11 (65)	12 (67)
	1000 ≤	12	6 (35)	6 (33)	0.815
Operation time (min)	< 330	19	10 (59)	9 (50)
	330 ≤	16	7 (41)	9 (50)	0.854
Preoperative Hb (g/dL)	<10	8	5 (29)	3 (17)
	10 ≤	27	12 (71)	15 (83)	0.443
Preoperative Alb (g/dL)	≤ 3.5	9	4 (27)	5 (29)
	3.5 <	23	11 (74)	12 (71)	0.825
2Lymphocyte counts (/mm3)	< 1400	26	9 (53)	17 (94)
	1400 ≤	9	8 (47)	1 (6)	0.0073

¹P values were derived from the χ² or Fisher's exact test and were considered significant at < 0.05;

²Lymphocyte counts at the diagnosis of postoperative pancreatic fistula;

³Significant values. ISGPF: International Study Group on Pancreatic Fistula; BMI: Body mass index.

Table 4 Results of multivariable logistic regression; risk factor for extremely severe postoperative pancreatic fistula

Covariate	OR	95% Confidence limit	P value
Lymphocyte counts (/mm3)
< 1400 vs 1400 ≤	10.45	1.05-104.1	0.045
Age (yr)
65 ≤vs < 65	3.39	0.602-1.886	0.166