• Manabu Kawai, Satoshi Kondo, Hiroki Yamaue, Keita Wada, Keiji Sano, Fuyuhiko Motoi, Michiaki Unno, Sohei Satoi, A-Hon Kwon, Takashi Hatori, Masakazu Yamamoto, Joe Matsumoto, Yoshiaki Murakami, Ryuichiro Doi, Masahiro Ito, Shuichi Miyakawa, Hiroyuki Shinchi, Shoji Natsugoe, Hisatoshi Nakagawara, Tetsuo Ohta, and Tadahiro Takada.
• Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan.
• J Hepatobiliary Pancreat Sci. 2011 Jul 1; 18 (4): 601-8.

Background/PurposeIt 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).MethodThe 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.ResultsA 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.ConclusionThe 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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