title: Risk factors influencing pancreatic leakage and the mortality after pancreaticoduodenectomy in a medium-volume hospital.
abstract: OBJECTIVE
  This study was designed to evaluate risk factors influencing pancreatic leakage and pancreatic leakage-related mortality in a medium-volume hospital.
  
  
  METHODS
  We retrospectively reviewed the clinical records of 107 patients who underwent pancreaticoduodenectomy at the Kobe University Hospital. Fourteen predictive factors for pancreatic leakage and the pancreatic leakage-related mortality were evaluated using univariate and multivariate logistic regression models.
  
  
  RESULTS
  In univariate analysis, the degree of pancreatic fibrosis, type of resection (PD/PPPD), anastomosis techniques (invagination or duct-to-mucosa anastomosis), anastomosis sites (jejunum/stomach), and the presence of congestion in anastomosis sites significantly influenced pancreatic leakage, and the degree of pancreatic fibrosis influenced pancreatic leakage-related mortality. Multivariate logistic regression analysis revealed that congestion in anastomosis sites was the strongest parameter for pancreatic leakage. Univariate analysis of the patients with normal/mild fibrosing pancreas revealed that pancreatic leakage was influenced by type of resection, anastomosis techniques, anastomosis sites, congestion in anastomosis sites and the management of pancreas parenchyma.
  
  
  CONCLUSIONS
  In a medium-volume hospital, reconstruction after pancreaticoduodenectomy should be performed with careful attention to pancreas and anastomosis sites. In the patients with normal/mild fibrosing pancreas, duct-to-mucosa anastomosis without suturing the pancreas parenchyma may be a useful technique for reconstruction.
authors.affiliation: Department of Gastroenterological Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan. yasu120@med.kobe-u.ac.jp
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Fujino
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Suzuki
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Ajiki
authors.forename: Yasuki
authors.initials: Y
authors.lastname: Tanioka
authors.forename: Yonson
authors.initials: Y
authors.lastname: Ku
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Kuroda
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D001661:Biliary Tract Neoplasms / Q000401:mortality / Q000601:surgery*; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000401:mortality / Q000601:surgery*; D017052:Hospital Mortality; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000401:mortality / Q000601:surgery*; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D011183:Postoperative Complications / Q000401:mortality*; D012307:Risk Factors; D013529:Surgical Wound Dehiscence / Q000401:mortality*