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Predictive risk factors for clinically relevant pancreatic fistula analyzed in 1,239 patients with pancreaticoduodenectomy: multicenter data collection as a project study of pancreatic surgery by the Japanese Society of Hepato-Biliary-Pancreatic Surgery

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Journal of Hepato-Biliary-Pancreatic Sciences

Abstract

Background/purpose

It is important to predict the development of clinically relevant pancreatic fistula (grade B/C) in the early period after pancreaticoduodenectomy (PD). This study has been carried out as a project study of the Japanese Society of Hepato-Biliary-Pancreatic Surgery (JSHPBS) to evaluate the predictive factors associated with clinically relevant pancreatic fistula (grade B/C).

Method

The data of 1,239 patients from 11 medical institutions who had undergone PD between July 2005 and June 2009 were retrospectively analyzed to review patient characteristics and perioperative and postoperative parameters.

Results

A drain amylase level >4,000 IU/L on postoperative day (POD) 1 was proposed as the cut-off level to predict clinical relevant pancreatic fistula by the receiver operating characteristic (ROC) curve. The sensitivity, specificity, and accuracy of this cut-off level were 62.2, 89.0, and 84.8%, respectively. A multivariate logistic regression analysis revealed that male [odds ratio (OR) 1.7, P = 0.039], intraoperative bleeding >1,000 ml (OR 2.5, P = 0.001), soft pancreas (OR 2.7, P = 0.001), and drain amylase level on POD 1 >4,000 IU/L (OR 8.6, P < 0.001) were the significant predictive factors for clinical pancreatic fistula.

Conclusion

The four predictive risk factors identified here can provide useful information useful for tailoring postoperative management of clinically relevant pancreatic fistula (grade B/C).

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Author information

Authors and Affiliations

  1. Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan

    Manabu Kawai & Hiroki Yamaue

  2. Department of Surgical Oncology, Hokkaido University Graduate School of Medicine, N15 W7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan

    Satoshi Kondo & Joe Matsumoto

  3. Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan

    Keita Wada & Keiji Sano

  4. Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan

    Fuyuhiko Motoi & Michiaki Unno

  5. Department of Surgery, Kansai Medical University, Moriguchi, Osaka, Japan

    Sohei Satoi & A-Hon Kwon

  6. Department of Surgery, Institute of Gastroenterology, Tokyo Women’s Medical University, Tokyo, Japan

    Takashi Hatori & Masakazu Yamamoto

  7. Division of Clinical Medical Science, Department of Surgery, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan

    Yoshiaki Murakami

  8. Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kyoto University, Kyoto, Japan

    Ryuichiro Doi

  9. Department of Biliary Pancreatic Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan

    Masahiro Ito & Shuichi Miyakawa

  10. Department of Surgical Oncology, Kagoshima University, Kagoshima, Kagoshima, Japan

    Hiroyuki Shinchi & Shoji Natsugoe

  11. Department of Gastroenterological Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa, Japan

    Hisatoshi Nakagawara & Tetsuo Ohta

  12. Japanese Society of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan

    Tadahiro Takada

Authors
  1. Manabu Kawai
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  2. Satoshi Kondo
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  3. Hiroki Yamaue
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  4. Keita Wada
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  5. Keiji Sano
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  6. Fuyuhiko Motoi
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  7. Michiaki Unno
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  8. Sohei Satoi
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  9. A-Hon Kwon
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  10. Takashi Hatori
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  11. Masakazu Yamamoto
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  12. Joe Matsumoto
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  13. Yoshiaki Murakami
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  14. Ryuichiro Doi
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  15. Masahiro Ito
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  16. Shuichi Miyakawa
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  17. Hiroyuki Shinchi
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  18. Shoji Natsugoe
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  19. Hisatoshi Nakagawara
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  20. Tetsuo Ohta
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  21. Tadahiro Takada
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Corresponding author

Correspondence to Satoshi Kondo.

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Kawai, M., Kondo, S., Yamaue, H. et al. Predictive risk factors for clinically relevant pancreatic fistula analyzed in 1,239 patients with pancreaticoduodenectomy: multicenter data collection as a project study of pancreatic surgery by the Japanese Society of Hepato-Biliary-Pancreatic Surgery. J Hepatobiliary Pancreat Sci 18, 601–608 (2011). https://doi.org/10.1007/s00534-011-0373-x

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  • DOI: https://doi.org/10.1007/s00534-011-0373-x

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