• Journal of Gastric Cancer
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• v.21 no.1
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• pp.30-37
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• 2021

Purpose: While the amylase concentration of the drainage fluid (dAmy) has been reported to be a predictor of postoperative pancreas-related complications (PPRC), the optimal timing for its measurement has not been fully investigated. Materials and Methods: The clinicopathological data of 387 patients who underwent elective gastrectomy for gastric cancer were reviewed. Laboratory data, including dAmy on postoperative days 1 (dAmy1) and 3 (dAmy3), and serum C-reactive protein (sCRP) concentrations on postoperative days 1 (sCRP1) and 3 (sCRP3) were compared between patients with PPRC and without PPRC. Results: Nineteen of the 387 patients (4.9%) developed PPRC. The optimal cutoff values of dAmy1, dAmy3, sCRP1, and sCRP3 were 1514 IU/L, 761 IU/L, 8.32 mg/dL, and 15.15 mg/dL, respectively. The area under the curve of dAmy1 was greater than that of dAmy3 (0.915 vs. 0.826), and that of sCRP3 was greater than that of sCRP1 (0.820 vs. 0.659). In the multivariate analysis, dAmy1 (P<0.001) and sCRP3 (P=0.004) were significant predictors of PPRC, while dAmy3 (P=0.069) and sCRP1 (P=0.831) were not. Thirteen (41.9%) of 31 patients with both dAmy1 ≥1,545 IU/L and sCRP3 ≥15.15 mg/dL had PPRC ≥Clavien-Dindo II. In contrast, among 260 patients with both dAmy1 <1,545 IU/L and sCRP3 <15.15 mg/dL, none developed PPRC. Conclusions: dAmy1 was more useful than dAmy3 in predicting PPRC. The combination of dAmy1 and sCRP3 may be a useful criterion for the removal of drains on postoperative day 3.

• Journal of Trauma and Injury
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• v.25 no.4
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• pp.115-121
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• 2012

Purpose: Severe pancreaticoduodenal injuries are relatively uncommon, but may result in high morbidity and mortality, especially when management is not optimal, and determining the appropriate treatment is often difficult. The objective of this study was to review our experience and to evaluate the role of a pancreaticoduodenectomy (PD) in treatment of pancreaticoduodenal injuries. Methods: We performed a retrospective review of 16 patients who underwent an emergency PD at our hospital for severe pancreaticoduodenal injury from 1990 to 2011. Demographic data, clinical manifestations, mechanism and severity of the injury, associated injuries, postoperative complications and outcomes were reviewed. Results: The mean age of the 16 patients was $45{\pm}12years$ ($mean{\pm}standard$ deviation), and 15(93.8%) patients were male. All patients underwent an explorative laparotomy after a diagnosis using abdominal computed tomography. Almost all patients were classified as AAST grade higher than III. Thirteen(83.3%) of the 16 patients presented with blunt injuries; none presented with a penetrating injury. Only one(6.3%) patients had a combined major vascular injury. Fifteen patients underwent a standard Whipple's operation, and 1 patient underwent a pylorus-preserving pancreaticoduodenectomy. Two of the 16 patients required an initial damage-control procedure; then, a PD was performed. The most common associated injured organs were the small bowel mesentery(12, 75%) and the liver(7, 43.8%). Complications were intraabdominal abscess(50%), delayed gastric emptying(37.5%), postoperative pancreatic fistula(31.5%), and postoperative hemorrhage (12.5%). No mortalities occurred after the PD. Conclusion: Although the postoperative morbidity rate is relatively higher, an emergency PD can be perform safely without mortality for severe pancreaticoduodenal injuries. Therefore, an emergency PD should be considered as a life-saving procedure applicable to patients with unreconstructable pancreaticoduodenal injuries, provided that is performed by an experienced hepatobiliary surgeon and the patient is hemodynamically stable.

• Journal of Gastric Cancer
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• v.7 no.2
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• pp.74-81
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• 2007

Purpose: Routine pancreatico-splenectomy with total gastrectomy should no longer be considered as the standard surgical procedure for gastric cancer because of the lack of proven surgical benefit for survival. The aim of this study is to evaluate the clinicopathologic factors and the survival of patients with locally advanced gastric cancer and they had undergone combined pancreatico-splenectomy with a curative intent. Material and Methods: We retrospectively reviewed a total of 118 patients who had undergone total gastrectomy with distal pancreatico-splenectomy from 1990 to 2001. The patients were divided into 2 groups: 90 patients who were free from cancer invasion (group I), and 28 patients with histologically proven cancer invasion into the pancreas (group II). The various clinicopathologic factors that were presumed to influence survival and the survival rates were analyzed. Results: The rate of pathological pancreatic invasion was 23.7%. The tumor stage, depth of invasion, pancreas invasion, lymph node metastasis, lymph node ratio, curability and the hepatic and peritoneal metastasis were statistically significance on univariate analysis. Among these factors, the tumor stage, lymph node ratio and curability were found to be independent prognostic factor on multivariate analysis. The 5-years survival rates were 36.2% for group I and 13.9% for group II. The morbidity rate was 22.1%, and this included pancreatic fistula (5.1%), intra-abdominal abscess (4.2%) and bleeding (4.2%). The overall mortality rate was 0.8%. Conclusion: Combined distal pancreatico-splenectomy with total gastrectomy with a curative intent was selectively indicated for those patients with visible tumor invasion to the pancreas, a difficult complete lymph node dissection around the distal pancreas and spleen, and no evidence of liver metastasis or peritoneal dissemination.