title: Risk factors for postoperative pancreatic fistulization subsequent to enucleation.
abstract: BACKGROUND
  Pancreatectomies increase the risk of postoperative pancreatic fistula (POPF) and pancreatic insufficiency. Pancreatic enucleation preserves pancreatic parenchyma, lowers the risk of pancreatic insufficiency, but may induce specific complications (tumor recurrence or pancreatic fistulization). The aim of this study was to determine the risk factors for POPF following a pancreatic enucleation.
  
  
  METHODS
  A retrospective analysis was designed based on data from patients who underwent pancreatic enucleation in five university hospitals (1998-2008). The presence of a pancreatic fistula was determined according to the criteria of the International Study Group of Pancreatic Fistula (Bassi et al. Surgery 138:8-13, 2005).
  
  
  RESULTS
  Fifty-two patients (mean age 52 years) were included. Histological analysis revealed 35 endocrine tumors (68.6 %), 6 mucinous and 2 serous cyst adenomas, 2 metastases of renal cancer, and 8 benign tumors. Nineteen patients (36.5%) suffered postoperative complications including 14 POPF (27 %). Median postoperative hospital stay was 12.9 days; 9.1 days without POPF versus 29 days with POPF (p < 0.05). Size of the tumor, its location, histological differentiation, and use of somatostatin analogs were not predictors for POPF. We defined the cutoff for POPF at a distance of 2 mm from the main pancreatic duct based on 60% risk (≤2 mm) versus 19 % (>2 mm) of POPF (p < 0.01). With a mean follow-up of 30.8 months, one patient experienced recurrence of the tumor. No patients exhibited a new onset of diabetes or pancreatic insufficiency.
  
  
  CONCLUSIONS
  Enucleation for resection of pancreatic tumors located at less than or equal to two 2 mm from the main pancreatic duct is a risk factor for POPF. Enucleation is a safe and effective treatment for benign or borderline pancreatic tumors.
authors.affiliation: Department of Digestive and endocrine surgery, Clinique de Chirurgie Digestive et Endocrinienne, IMAD, University Hospital, Place Ricordeau, 44093 NANTES, France.
authors.forename: Céline
authors.initials: C
authors.lastname: Brient
authors.forename: Nicolas
authors.initials: N
authors.lastname: Regenet
authors.forename: Laurent
authors.initials: L
authors.lastname: Sulpice
authors.forename: Laurent
authors.initials: L
authors.lastname: Brunaud
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Mucci-Hennekine
authors.forename: Nicolas
authors.initials: N
authors.lastname: Carrère
authors.forename: Jenifer
authors.initials: J
authors.lastname: Milin
authors.forename: Ahmet
authors.initials: A
authors.lastname: Ayav
authors.forename: Bernard
authors.initials: B
authors.lastname: Pradere
authors.forename: Antoine
authors.initials: A
authors.lastname: Hamy
authors.forename: Laurent
authors.initials: L
authors.lastname: Bresler
authors.forename: Bernard
authors.initials: B
authors.lastname: Meunier
authors.forename: Eric
authors.initials: E
authors.lastname: Mirallié
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D010180:Pancreatectomy / Q000379:methods*; D010183:Pancreatic Ducts / Q000473:pathology; D010185:Pancreatic Fistula / Q000453:epidemiology / Q000209:etiology*; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome