• Motokazu Sugimoto, Shinichiro Takahashi, Naoto Gotohda, Yuichiro Kato, Takahiro Kinoshita, Hidehito Shibasaki, and Masaru Konishi.
• Department of Digestive Surgical Oncology, National Cancer Center Hospital East, 6-5-1, Kashiwa-no-ha, Kashiwa, Chiba Prefecture, 277-8577, Japan.
• J. Gastrointest. Surg. 2013 Oct 1; 17 (10): 1744-51.

IntroductionPostoperative pancreatic fistula (POPF) remains a serious complication after pancreaticoduodenectomy (PD). Preoperative risk assessment of POPF is desirable in careful preparation for operation. The aim of this study was to assess simple and accurate risk factors for clinically relevant POPF based on a schematic understanding of the pancreatic configuration using preoperative multidetector computed tomography.MethodsThree hundred and eighteen consecutive patients who underwent PD in the National Cancer Center Hospital East between November 2006 and March 2013 were investigated. Pre-, intra-, and postoperative clinicopathological findings as well as pancreatic configuration data were analyzed for the risk of clinically relevant POPF. POPF was defined according to the International Study Group of Pancreatic Fistula classification. POPF grade A occurred in 52 patients (16.4%), grade B in 84 (26.4%), and grade C in 6 (1.9%).ConclusionsIndependent risk factors for POPF grade B/C included main pancreatic duct diameter (MPDd) < 2 mm (P = 0.001), parenchymal thickness ≥ 8 mm (P = 0.018), not performing portal vein/superior mesenteric vein resection (P = 0.004), and amylase level of drainage fluid on postoperative day 3 ≥ 375 IU/L (P < 0.001). Pancreatic configuration data including MPDd and parenchymal thickness were good indicators of clinically relevant POPF.

18 keywords...

hide…