Pancreas-contactless open gastrectomy for gastric cancer and postoperative pancreatic complications: A retrospective cohort study.

BACKGROUND

Postoperative pancreatic fistula (POPF) is a serious complication after gastrectomy, particularly during suprapancreatic lymph node dissection. While a pancreas-contactless technique reduces POPF in minimally invasive surgery, its impact in open gastrectomy remains unclear. This study compared outcomes between pancreas-contact and pancreas-contactless techniques in open gastrectomy for gastric cancer.

METHODS

Patients who underwent open gastrectomy for gastric cancer between 2015 and 2024 were retrospectively reviewed. They were classified into the contact group, in which the pancreas was compressed with gauze, and the contactless group, in which the suprapancreatic area was exposed by retracting the root of the transverse mesocolon along the inferior border of the pancreas without direct pancreatic contact. Perioperative outcomes were compared, and propensity score matching (PSM) was performed to adjust for baseline differences.

RESULTS

A total of 161 patients were included (contact n = 66; contactless n = 95). Operative time was longer in the contactless group (399 vs 330 min, p < 0.001), whereas blood loss and hospital stay were similar. POPF was less frequent in the contactless group (0 vs 7.6%, p = 0.006), as was intra-abdominal abscess (3.2 vs 12.1%, p = 0.027). Body temperature on postoperative day 5 was lower before matching (p = 0.043), and on postoperative day 1 remained lower after PSM (p = 0.047). After PSM, the contactless group continued to show significantly fewer POPF and abscess cases.

CONCLUSION

Pancreas-contactless open gastrectomy was associated with lower rates of POPF and intra-abdominal abscess without worsening perioperative outcomes.