title: Recurrence pattern and prognosis of pancreatic cancer after pancreatic fistula.
abstract: BACKGROUND
  The negative impact of anastomotic leakage on cancer-specific survival and recurrence patterns has been recognized in colorectal cancer. In pancreatic cancer, pancreatic fistula (PF) is a serious morbidity, but its negative effect on long-term outcome remains to be elucidated. The aim of this study was to determine the impact of PF on pancreatic cancer recurrence.
  
  
  METHODS
  The medical records of 184 patients with curative pancreatectomy for pancreatic cancer were reviewed. PF was scored on the basis of the International Study Group of Pancreatic Fistula classification. Overall and disease-free survivals and recurrence patterns were analyzed. Grade A PF was excluded because the negative effects can be negligible.
  
  
  RESULTS
  PF occurred in 51 of the 184 patients (27.7%). The mortality related to PF was 0.5% (1 of 184). PF was an independent risk factor for peritoneal recurrence (hazard ratio 3.974; 95% confidence interval 1.345-11.737; P = 0.013). According to the analysis of disease-free survival in patients with peritoneal recurrence, time to recurrence was shorter and the survival rate was worse in patients with PF than in those without PF (5.6 vs. 8.2 months; 6-month survival, 40 vs. 71%; 1-year survival, 7 vs. 19%; P = 0.053). PF was an independent prognostic factor after multivariate analysis (hazard ratio 3.257; 95% confidence interval 1.201-8.828; P = 0.020).
  
  
  CONCLUSIONS
  PF was statistically significantly related to peritoneal recurrence, and patients with PF developed peritoneal recurrence earlier than those without PF. With regard to the development of peritoneal recurrence, PF may be considered to be a negative prognostic factor.
authors.affiliation: Department of Surgery II, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
authors.forename: Shunji
authors.initials: S
authors.lastname: Nagai
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Fujii
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kodera
authors.forename: Mitsuro
authors.initials: M
authors.lastname: Kanda
authors.forename: Tevfik T
authors.initials: TT
authors.lastname: Sahin
authors.forename: Akiyuki
authors.initials: A
authors.lastname: Kanzaki
authors.forename: Masamichi
authors.initials: M
authors.lastname: Hayashi
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Sugimoto
authors.forename: Shuji
authors.initials: S
authors.lastname: Nomoto
authors.forename: Shin
authors.initials: S
authors.lastname: Takeda
authors.forename: Satoshi
authors.initials: S
authors.lastname: Morita
authors.forename: Akimasa
authors.initials: A
authors.lastname: Nakao
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000401:mortality* / Q000601:surgery; D010180:Pancreatectomy; D010185:Pancreatic Fistula / Q000150:complications / Q000401:mortality* / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000209:etiology / Q000401:mortality* / Q000601:surgery; D010534:Peritoneal Neoplasms / Q000209:etiology / Q000401:mortality* / Q000601:surgery; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome