title: Schematic pancreatic configuration: a risk assessment for postoperative pancreatic fistula after pancreaticoduodenectomy.
abstract: BACKGROUND
  Postoperative pancreatic fistula (POPF) remains a serious complication after pancreaticoduodenectomy (PD). Preoperative risk assessment of POPF is desirable in careful preparation for operation. The aim of this study was to assess simple and accurate risk factors for clinically relevant POPF based on a schematic understanding of the pancreatic configuration using preoperative multidetector computed tomography.
  
  
  METHODS
  Three hundred and eighteen consecutive patients who underwent PD in the National Cancer Center Hospital East between November 2006 and March 2013 were investigated. Pre-, intra-, and postoperative clinicopathological findings as well as pancreatic configuration data were analyzed for the risk of clinically relevant POPF. POPF was defined according to the International Study Group of Pancreatic Fistula classification. POPF grade A occurred in 52 patients (16.4%), grade B in 84 (26.4%), and grade C in 6 (1.9%).
  
  
  CONCLUSIONS
  Independent risk factors for POPF grade B/C included main pancreatic duct diameter (MPDd) < 2 mm (P = 0.001), parenchymal thickness ≥ 8 mm (P = 0.018), not performing portal vein/superior mesenteric vein resection (P = 0.004), and amylase level of drainage fluid on postoperative day 3 ≥ 375 IU/L (P < 0.001). Pancreatic configuration data including MPDd and parenchymal thickness were good indicators of clinically relevant POPF.
authors: Department of Digestive Surgical Oncology, National Cancer Center Hospital East, 6-5-1, Kashiwa-no-ha, Kashiwa, Chiba Prefecture, 277-8577, Japan.
authors: Motokazu
authors: M
authors: Sugimoto
authors: Shinichiro
authors: S
authors: Takahashi
authors: Naoto
authors: N
authors: Gotohda
authors: Yuichiro
authors: Y
authors: Kato
authors: Takahiro
authors: T
authors: Kinoshita
authors: Hidehito
authors: H
authors: Shibasaki
authors: Masaru
authors: M
authors: Konishi
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D061330:Multidetector Computed Tomography; D010179:Pancreas / Q000000981:diagnostic imaging* / Q000473:pathology; D010185:Pancreatic Fistula / Q000453:epidemiology* / Q000209:etiology*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors
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