title: Pancreatic fistula after a pancreaticoduodenectomy for ductal adenocarcinoma and its association with morbidity: a multicentre study of the French Surgical Association.
abstract: BACKGROUND
  A pancreatic fistula (PF) is the most relevant complication after a pancreaticoduodenectomy (PD). This retrospective multicentric study attempts to elucidate the risk factors and complications of a PF in a large cohort of patients undergoing a PD for ductal adenocarcinoma.
  
  
  METHODS
  Using a survey tool, clinical data of 1325 patients undergoing a PD for ductal adenocarcinoma at 37 institutions, between January 2004 and December 2009, were collected. Peri-operative risk factors associated with PF and its association with morbidity and mortality were assessed. Morbidity and PF were graded according to the ISGPF (International Study group for pancreatic fistula) definition and the Dindo-Clavien classification.
  
  
  RESULTS
  Overall PF, mortality, morbidity and relaparotomy rates were 14.3%, 3.8%, 54.4% and 11.7%, respectively. PF occurred more frequently after a pancreaticojejunostomy (PJ) compared with a pancreaticogastrostomy (PG) (16.8% vs. 10.4%; P = 0.0012). Independent risk factors for PF by multivariate analysis were absence of pre-operative diabetes (P = 0.0014), PJ reconstruction (P = 0.0035), soft pancreatic parenchyma (P < 0.0001) and low-volume centre (P = 0.0286). Clinically relevant PF (grade B and C) and severe complications (Dindo-Clavien grade IIIB, IV, V) were significantly more frequent after PJ than PG (71.6% vs. 28.3%; P = 0.030 and 24.8% vs. 19.1%; P = 0.015, respectively). Overall mortality and relaparotomy rates were similar after PG and PJ.
  
  
  CONCLUSIONS
  A soft pancreatic parenchyma, the absence of pre-operative diabetes, PJ and low-volume centre are independent risk factors for PF after PD for ductal adenocarcinoma. A significantly higher incidence and clinical severity of PF are associated with PJ.
authors: Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Hopital de Hautpierre, Université de Strasbourg, Strasbourg, France.
authors: Pietro
authors: P
authors: Addeo
authors: Jean Robert
authors: JR
authors: Delpero
authors: Francois
authors: F
authors: Paye
authors: Elie
authors: E
authors: Oussoultzoglou
authors: Pascal R
authors: PR
authors: Fuchshuber
authors: Alain
authors: A
authors: Sauvanet
authors: Antonio
authors: A
authors: Sa Cunha
authors: Yves Patrice
authors: YP
authors: Le Treut
authors: Mustapha
authors: M
authors: Adham
authors: Jean-Yves
authors: JY
authors: Mabrut
authors: Laurence
authors: L
authors: Chiche
authors: Philippe
authors: P
authors: Bachellier
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016009:Chi-Square Distribution; D048909:Diabetes Complications / Q000209:etiology; D005260:Female; D005602:France; D017052:Hospital Mortality; D061847:Hospitals, High-Volume; D061846:Hospitals, Low-Volume; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010185:Pancreatic Fistula / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000401:mortality; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome