title: Risk factors of pancreatic fistula after pancreaticoduodenectomy - patients with low drain amylase level on postoperative day 1 are safe from developing pancreatic fistula.
abstract: OBJECTIVE
  Based on the criteria of International Study Group on Pancreatic Fistula (ISGPF), the risk factors for grade B/C pancreatic fistula (PF) after pancreaticoduodenectomy (PD) were analyzed in this study.
  
  
  METHODS
  Between October 2006 and August 2010, 114 consecutive patients underwent PD at National Hospital Organization Osaka National Hospital. We compared the clinicopathological features between patients with grade B/C PF and those with PF-free/grade A PF. We also examined the relationship between PF formation and the drain amylase level on post-operative day (POD) 1 and POD 3.
  
  
  RESULTS
  Eighteen patients (15.8%) developed grade B/C P. Of these patients, four patients underwent reoperation. The mortality rate in patients with grade B/C PF was 5.6%(1/18). The non-dilated pancreatic duct (≤ 3mm) was the only independent risk factor for grade B/C PF by a multivariate analysis (p=0.026). There were 45 patients who showed low (≤ three times serum amylase level)drain amylase level on POD 1 and none of them developed PF.
  
  
  CONCLUSIONS
  Although our study demonstrated that the non-dilated pancreatic duct is significantly correlated with the increased incidence of grade B/CPE patients with low amylase level of drainage fluid on POD 1 are thought to be safe from developing PE.
authors.affiliation: Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan. tsujie@nara.med.kindai.ac.jp
authors.forename: Masanori
authors.initials: M
authors.lastname: Tsujie
authors.forename: Shoji
authors.initials: S
authors.lastname: Nakamori
authors.forename: Atsushi
authors.initials: A
authors.lastname: Miyamoto
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Yasui
authors.forename: Masakazu
authors.initials: M
authors.lastname: Ikenaga
authors.forename: Motohiro
authors.initials: M
authors.lastname: Hirao
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Fujitani
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Mishima
authors.forename: Toshimasa
authors.initials: T
authors.lastname: Tsujinaka
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000681:Amylases / Q000032:analysis*; D015415:Biomarkers / Q000032:analysis; D016009:Chi-Square Distribution; D015536:Down-Regulation; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010185:Pancreatic Fistula / Q000175:diagnosis / Q000201:enzymology / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D000681:Amylases