title: Body mass index is a risk factor of pancreatic fistula after pancreaticoduodenectomy.
abstract: Pancreatic fistula (PF) after pancreaticoduodenectomy (PD) is still a severe complication and a challenging problem. The common risk factors are the soft pancreas and small pancreatic duct of the remnant pancreas. Those two risk factors were recognized during surgery. On the other hand,  a preoperatively determined risk factor of PF is unclarified. We conducted a retrospective analysis of 203 patients consecutively treated by PD from April 2000 to October 2010. PF was defined according to the criteria of the International Study Group of Pancreatic Fistula. Clinical and pre-  and intraoperative data were compared between PF and non-PF patients. The recommended cutoff value of body mass index (BMI) as 20 kg/m(2) was defined by receiver operating characteristic curve analysis. PF occurred in 53 (26.1%) of 203 patients. In univariate analysis, BMI and soft  remnant pancreas were found to be risk factors of PF (P = 0.027, P = 0.005). In multivariate analysis, BMI and soft pancreas were also risk factors of PF (P = 0.040, P = 0.005). Patients with PF had a significantly longer hospital stay than non-PF patients (P  = 0.005). High BMI and soft pancreas were significant risk factors for PF.
authors.affiliation: Second Department of Surgery, Dokkyo Medical University, Tochigi, Japan. shimodamitsugi@hotmail.com
authors.forename: Mitsugi
authors.initials: M
authors.lastname: Shimoda
authors.forename: Masato
authors.initials: M
authors.lastname: Katoh
authors.forename: Iso
authors.initials: I
authors.lastname: Yukihiro
authors.forename: Junji
authors.initials: J
authors.lastname: Kita
authors.forename: Tokihiko
authors.initials: T
authors.lastname: Sawada
authors.forename: Keiichi
authors.initials: K
authors.lastname: Kubota
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010185:Pancreatic Fistula / Q000453:epidemiology / Q000209:etiology*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors