A novel postoperative inflammatory score predicts postoperative pancreatic fistula after pancreatic resection.
OBJECTIVE
The aim of this study was to characterize a high-risk group of patients for pancreatic fistula (PF) after pancreatic resection using postoperative clinical variables of patients.


METHODS
The retrospective study included 297 patients who underwent pancreatic resection between January 2001 and December 2011. We examined the relationship between perioperative findings and the incidence of postoperative PF (POPF) among patients who underwent pancreatic resection between 2001 and 2009 (early period). Next, patients were stratified into three groups using serum albumin and CRP on postoperative day 1 (score 0: albumin ≥2.7 g/dl and CRP ≤10 mg/dl; score 1: albumin <2.7 g/dl or CRP >10 mg/dl; score 2: albumin <2.7 g/dl and CRP >10 mg/dl) as postoperative inflammatory score (PIS). We examined perioperative findings including PIS and POPF among patients who underwent pancreatic resection between 2010 and 2011 (late period).


RESULTS
In univariate and multivariate analyses, male gender (p=0.032), serum albumin on postoperative day 1 (p=0.024) and serum CRP on postoperative day 1 were identified as independent risk factors for POPF in early-period patients. In univariate and multivariate analyses, postoperative hospital stay (p=0.009) and PIS (score 1: p=0.005, score 2: p=0.017) were identifical as independent risk factors for POPF in late-period patients.


CONCLUSIONS
We found a novel PIS to indicate risk for PF after elective pancreatic resection.
The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo 105-8461, Japan. sheetan@jikei.ac.jp.
Yuki
Y
Fujiwara
Takeyuki
T
Misawa
Hiroaki
H
Shiba
Yoshihiro
Y
Shirai
Ryota
R
Iwase
Koichiro
K
Haruki
Kenei
K
Furukawa
Yasuro
Y
Futagawa
Katsuhiko
K
Yanaga
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000032:analysis*; D002097:C-Reactive Protein / Q000032:analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007249:Inflammation / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010180:Pancreatectomy / Q000009:adverse effects*; D010185:Pancreatic Fistula / Q000175:diagnosis* / Q000209:etiology; D010190:Pancreatic Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis; D055815:Young Adult
D014408:Biomarkers, Tumor; D012709:Serum Albumin; D002097:C-Reactive Protein
Postoperative pancreatic fistula; pancreatic resection; serum C-reactive protein; serum albumin