title: Risk factor for pancreatic fistula after pancreaticoduodenectomy performed by a surgeon during a learning curve: analysis of a single surgeon's experiences of 100 consecutive patients.
abstract: OBJECTIVE
  Among several kinds of morbidities, pancreatic fistula (PF) is the most common complication of pancreaticoduodenectomy (PD). However, it has not been clarified what kind of perioperative factors are risk factors of PF after PD is performed by a training surgeon.
  
  
  METHODS
  We evaluated the risk factors of PF after PD in which all procedures for 100 consecutive patients were performed by a single training surgeon, retrospectively. The 100 cases were divided into two groups and the first 50 cases were named Group A and the latter 50 cases were named Group B.
  
  
  RESULTS
  Multivariate analysis demonstrated that the absence of main pancreatic duct dilatation was an independent risk factor for grade B and grade C PF (p=0.0080; OR=5.311; 95% CI=1.116-7.025). There was no significant difference of the frequencies of grade B and grade C PF between Group A and Group B (p=0.13361).
  
  
  CONCLUSIONS
  We demonstrated that the absence of main pancreatic duct dilatation was an independent risk factor for grade B and grade C PF after PD was performed by a training surgeon; for those without pancreatic duct dilatation, PD can be performed by a surgeon in the earlier training period with an acceptable rate of PF.
authors.affiliation: Department of Surgery, Saitama Medical Center, Jichi Medical University, Japan. noda164@hotmail.co.jp
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Noda
authors.forename: Hidenori
authors.initials: H
authors.lastname: Kamiyama
authors.forename: Takaharu
authors.initials: T
authors.lastname: Kato
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Watanabe
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Toyama
authors.forename: Fumio
authors.initials: F
authors.lastname: Konishi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D002983:Clinical Competence; D004108:Dilatation, Pathologic; D005260:Female; D006801:Humans; D007564:Japan; D059032:Learning Curve; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010183:Pancreatic Ducts / Q000473:pathology / Q000601:surgery; D010185:Pancreatic Fistula / Q000209:etiology*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult