title: 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.
abstract: OBJECTIVE
  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).
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  The four predictive risk factors identified here can provide useful information useful for tailoring postoperative management of clinically relevant pancreatic fistula (grade B/C).
authors.affiliation: Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Kawai
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kondo
authors.forename: Hiroki
authors.initials: H
authors.lastname: Yamaue
authors.forename: Keita
authors.initials: K
authors.lastname: Wada
authors.forename: Keiji
authors.initials: K
authors.lastname: Sano
authors.forename: Fuyuhiko
authors.initials: F
authors.lastname: Motoi
authors.forename: Michiaki
authors.initials: M
authors.lastname: Unno
authors.forename: Sohei
authors.initials: S
authors.lastname: Satoi
authors.forename: A-Hon
authors.initials: AH
authors.lastname: Kwon
authors.forename: Takashi
authors.initials: T
authors.lastname: Hatori
authors.forename: Masakazu
authors.initials: M
authors.lastname: Yamamoto
authors.forename: Joe
authors.initials: J
authors.lastname: Matsumoto
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Murakami
authors.forename: Ryuichiro
authors.initials: R
authors.lastname: Doi
authors.forename: Masahiro
authors.initials: M
authors.lastname: Ito
authors.forename: Shuichi
authors.initials: S
authors.lastname: Miyakawa
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Shinchi
authors.forename: Shoji
authors.initials: S
authors.lastname: Natsugoe
authors.forename: Hisatoshi
authors.initials: H
authors.lastname: Nakagawara
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Ohta
authors.forename: Tadahiro
authors.initials: T
authors.lastname: Takada
mesh_terms: D000368:Aged; D003625:Data Collection; D004067:Digestive System Neoplasms / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D010185:Pancreatic Fistula / Q000453:epidemiology* / Q000209:etiology; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D011183:Postoperative Complications; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012955:Societies, Medical; D011795:Surveys and Questionnaires; D015996:Survival Rate / Q000639:trends