title: Pancreatic anastomotic leakage after pancreaticoduodenectomy. Risk factors, clinical predictors, and management (single center experience).
abstract: BACKGROUND
  Postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD) remains a challenge even at high-volume centers.
  
  
  METHODS
  This study was designed to analyze perioperative risk factors for POPF after PD and evaluate the factors that predict the extent and severity of leak. Demographic data, preoperative, intraoperative, and postoperative variables were collected.
  
  
  RESULTS
  A total of 471 consecutive patients underwent PD in our center. Fifty-seven patients (12.1 %) developed a POPF of any type; 21 patients (4.5 %) had a fistula type A, 22 patients (4.7 %) had a fistula type B, and the remaining 14 patients (3 %) had a POPF type C. Cirrhotic liver (P = 0.05), BMI > 25 kg/m(2) (P = 0.0001), soft pancreas (P = 0.04), pancreatic duct diameter <3 mm (0.0001), pancreatic duct located <3 mm from the posterior border (P = 0.02) were significantly associated with POPF. With the multivariate analysis, both BMI and pancreatic duct diameter were demonstrated to be independent factors. The hospital mortality in this series was 11 patients (2.3 %), and the development of POPF type C was associated with a significantly increased mortality (7/14 patients). The following factors were predictors of clinically evident POPF: a postoperative day (POD) 1 and 5 drain amylase level >4,000 IU/L, WBC, pancreatic duct diameter <3 mm, and pancreatic texture.
  
  
  CONCLUSIONS
  Cirrhotic liver, BMI, soft pancreas, pancreatic duct diameter <3 mm, pancreatic duct near the posterior border are risk factors for development of POPF. In addition a drain amylase level >4,000 IU/L on POD 1 and 5, WBC, pancreatic duct diameter, pancreatic texture may be predictors of POPF B, C.
authors.affiliation: Department of Surgery, Gastroenterology Surgical Center, Mansoura University, Mansoura, Egypt. elnakeebayman@yahoo.com
authors.forename: Ayman
authors.initials: A
authors.lastname: El Nakeeb
authors.forename: Tarek
authors.initials: T
authors.lastname: Salah
authors.forename: Ahmad
authors.initials: A
authors.lastname: Sultan
authors.forename: Mohamed
authors.initials: M
authors.lastname: El Hemaly
authors.forename: Waleed
authors.initials: W
authors.lastname: Askr
authors.forename: Helmy
authors.initials: H
authors.lastname: Ezzat
authors.forename: Emad
authors.initials: E
authors.lastname: Hamdy
authors.forename: Ehab
authors.initials: E
authors.lastname: Atef
authors.forename: Ehab
authors.initials: E
authors.lastname: El Hanafy
authors.forename: Ahmed
authors.initials: A
authors.lastname: El-Geidie
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abdel Wahab
authors.forename: Talaat
authors.initials: T
authors.lastname: Abdallah
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000453:epidemiology / Q000601:surgery*; D015992:Body Mass Index; D002648:Child; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000473:pathology; D016577:Pancreaticoduodenectomy; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors