Pancreatic thickness as a predictive factor for postoperative pancreatic fistula after distal pancreatectomy using an endopath stapler.
OBJECTIVE
No consistent risk factor has yet been established for the development of pancreatic fistula (PF) after distal pancreatectomy (DP) with a stapler.


METHODS
A total of 31 consecutive patients underwent DP with an endopath stapler between June 2006 and December 2010 using a slow parenchymal flattening technique. The risk factors for PF after DP with an endopath stapler were identified based on univariate and multivariate analyses.


RESULTS
Clinical PF developed in 7 of 31 (22 %) patients who underwent DP with a stapler. The pancreata were significantly thicker at the transection line in patients with PF (19.4 ± 1.47 mm) in comparison to patients without PF (12.6 ± 0.79 mm; p = 0.0003). A 16-mm cut-off for pancreatic thickness was established based on the receiver operating characteristic (ROC) curve; the area under the ROC curve was 0.875 (p = 0.0215). Pancreatic thickness (p = 0.0006) and blood transfusion (p = 0.028) were associated with postoperative PF in a univariate analysis. Pancreatic thickness was the only significant independent factor (odds ratio 9.99; p = 0.036) according to a multivariate analysis with a specificity of 72 %, and a sensitivity of 85 %.


CONCLUSIONS
Pancreatic thickness is a significant independent risk factor for PF development after DP with an endopath stapler. The stapler technique is thus considered to be an appropriate modality in patients with a pancreatic thicknesses of <16 mm.
Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan. kokano@kms.ac.jp
Keiichi
K
Okano
Minoru
M
Oshima
Keitaro
K
Kakinoki
Naoki
N
Yamamoto
Shintaro
S
Akamoto
Shinichi
S
Yachida
Masanobu
M
Hagiike
Hideki
H
Kamada
Tsutomu
T
Masaki
Yasuyuki
Y
Suzuki
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D015999:Multivariate Analysis; D010179:Pancreas / Q000033:anatomy & histology* / Q000000981:diagnostic imaging / Q000601:surgery; D010180:Pancreatectomy / Q000295:instrumentation / Q000379:methods*; D010182:Pancreatic Diseases / Q000601:surgery; D010185:Pancreatic Fistula / Q000209:etiology* / Q000517:prevention & control; D011183:Postoperative Complications / Q000209:etiology* / Q000517:prevention & control; D011184:Postoperative Period; D057234:Preoperative Period; D012372:ROC Curve; D012307:Risk Factors; D013528:Surgical Staplers; D016896:Treatment Outcome