| BackgroundGastric cancer is a common malignant tumor of the digestive system,and radical gastrectomy is one of the main treatments for it.The operation involves lymph node dissection around the pancreas,especially in the upper edge of the pancreas,which often causes different degrees of pancreatic injury.Poor control of pancreatic injury can lead to postoperative pancreatic fistula(POPF),which in turn can lead to abdominal bleeding,anastomotic leakage,abdominal infection,abdominal abscess,and even life-threatening.The severity of pancreatic injury after gastrectomy is judged by monitoring the amylase concentration of drainage fluid.Pancreatic injury was considered when drainage fluid amylase concentration is more than 3 times the upper limit of normal serum amylase value on postoperative day(POD)1.If the drainage fluid amylase concentration is still more than that value on or after POD3,pancreatic injury has developed into POPF.Somatostatin analogues(SSA)can inhibit the exocrine function of pancreas and reduce the secretion of pancreatic juice.However,the application value of SSA after radical gastrectomy has not been clearly determined,few clinical trials have evaluated the effect of SSA on pancreatic injury after radical gastrectomy.Objective1.To evaluate the effect of SSA on pancreatic injury after radical gastrectomy.2.To analyze the risk factors associated with pancreatic injury after radical gastrectomy.Methods1.Patients who underwent radical gastrectomy in the Department of Gastrointestinal Surgery,eastern district of Shandong Provincial Hospital were screened.According to the concentration of drainage fluid amylase on POD1,the patients were divided into low amylase group(drainage fluid amylase ≤3 times the upper limit of serum amylase value)and high amylase group(drainage fluid amylase>3 times the upper limit of serum amylase value).1.1 Patients in the high amylase group were enrolled in the randomized controlled trial and randomly assigned to the trail group and the control group at a ratio of 1:1.The former received continuous intravenous octreotide acetate injection(0.3 mg/8 h)for 3 days from POD1,and the latter normal saline.The primary outcome was the incidence of POPF.The secondary outcomes were the incidence of postoperative short-term complications,abdominal drainage volume and duration,time to first flatus,time to first liquid diet,postoperative hospital stays and hospitalization expenses,serum and drainage fluid amylase concentrations,postoperative serum inflammatory indicators,liver and kidney function,and drug-related adverse reactions.Normal distribution measurement data were expressed as mean ± standard deviation(x±s),and independent-sample T test was used for comparison between groups.Measurement data with skewed distribution were expressed as median and interquartile range M(P25,P75),and comparison between groups was analyzed using the Mann-Whitney U test.Qualitative data were expressed as the number of cases and percentage n(%),and comparison between groups was analyzed using the chi-square test,continuous correction chi-square test or Fisher’s exact test.A P value of less than 0.05 was considered statistically significant.1.2 The basic information,surgical results and postoperative pathological data of patients in the high amylase group and the low amylase group were collected and compared,and the risk factors related to pancreatic injury after radical gastrectomy were analyzed by univariate and multivariate analysis.2.The date were statistically analyzed using SPSS 26.0.The measurement date with normal distribution were expressed as mean±standard deviation(x±s)and the measurement date with non-normal distribution were expressed as median and interquartile range M(P25,P75).The comparison between groups was performed by independent sample T test or Mann-Whitney U test.Count data were expressed as the numbers and percentage n(%),andχ2 test or Fisher’s exact test were used for comparison between groups.Risk factors that might affect pancreatic injury with a univariate P<0.05 were included in the multivariate analysis using multivariable logistic regression analysis.P<0.05 was considered significant.Results1.A total of 278 patients who underwent radical gastrectomy from February 2022 to July 2022 were collected,3 patients who declined to participate in the study and 4 patients whose tumors obviously invaded the pancreas were excluded.Finally,148 patients had drainage fluid amylase ≤3 times the upper limit of normal serum amylase on POD1.123 patients had drainage fluid amylase>3 times the upper limit of normal serum amylase on POD1 and were enrolled in the randomized controlled trial.2.The 123 patients enrolled in the randomized controlled trial were randomly assigned to the trail group(n=61)and the control group(n=62).The baseline characteristics were well-balanced between the two groups(P>0.05).The incidence of POPF in the trail group was lower than that in the control group(3.3%vs 14.5%,P=0.029).The incidence of short-term postoperative complications in the trail group was lower than that in the control group(9.8%vs 24.2%,P=0.034).Compared with the control group,the trail group had less abdominal drainage volume(289.00 ml vs 359.00 ml,P=0.025),shorter drainage duration(7 days vs 10 days,P=0.013),and earlier first liquid diet(87.33±17.92h vs 93.97±17.29h,P=0.039).There were no significant differences in the time to first flatus,postoperative hospital stays and hospitalization expenses between the two groups(P>0.05).There was no significant difference in drainage fluid and serum amylase concentration between the two groups after intervention(P>0.05).After intervention,the white blood cell count(P=0.023),neutrophil count(P=0.010),and the percentage of neutrophil count(P=0.014)in the trail group were lower than those in the control group,and the percentage of lymphocyte count(P=0.018)was higher than that in the control group.There were no statistically significant differences in PCT,IL-6,CRP,and lymphocyte count between the two groups(P>0.05).There were no significant differences in liver and kidney function,and drug-related adverse reactions between the two groups(P>0.05).3.Univariate analysis showed that BMI(P=0.011),extent of gastrectomy(P=0.003),number of peripancreatic lymph nodes dissection(P=0.001)and tumor differentiation(P=0.027)were significantly associated with pancreatic injury after radical gastrectomy.Age,gender,history of abdominal surgery,history of neoadjuvant therapy,history of diabetes mellitus,operative approach,tumor size,operation time,blood loss,total number of lymph node dissection,T stage,N stage,TNM stage were not associated with pancreatic injury(P>0.05).Multivariate analysis showed that BMI(OR=1.160,95%CI:1.062-1.266,P=0.001)and number of peripancreatic lymph nodes dissection(OR=1.079,95%CI:1.022-1.139,P=0.006)were independent risk factors associated with pancreatic injury after radical gastrectomy.Compared with proximal gastrectomy,distal gastrectomy(OR=2.882,95%CI:1.234-6.733,P=0.014)and total gastrectomy(OR=3.136,95%CI:1.216-8.088,P=0.018)were more likely to cause pancreatic injury.Conclusion1.The application of SSA can reduce the occurrence of POPF for patients with pancreatic injury after radical gastrectomy.At the same time,it can decrease the incidence of short-term complications,reduce abdominal drainage volume,shorten drainage duration,and reduce postoperative inflammatory response.2.BMI and the number of peripancreatic lymph nodes dissection were independent risk factors associated with pancreatic injury after radical gastrectomy.Compared with proximal gastrectomy,distal gastrectomy and total gastrectomy were more likely to cause pancreatic injury. |
PDF Full Text Request