title: Are there preoperative factors related to a "soft pancreas" and are they predictive of pancreatic fistulas after pancreatic resection?
abstract: OBJECTIVE
  Soft pancreatic parenchyma is the most widely recognized risk factor for pancreatic fistula. We conducted this study to clarify if there are preoperative factors related to a soft pancreatic remnant and to establish if they are useful for predicting pancreatic fistula.
  
  
  METHODS
  This was a retrospective study of patients who underwent pancreatic resections at the Department of Surgical Sciences of the S. Orsola-Malpighi Hospital, Bologna, Italy. The factors considered were sex, age, co-morbidities, body mass index, American Society of Anesthesiologists score, characteristics of the pancreatic remnant, and preoperative diagnosis.
  
  
  RESULTS
  Data from 208 patients were recorded. The risk factors predictive of a soft pancreatic remnant were BMI >24 kg/m(2) (P = 0.011), a Wirsung duct size ≤3 mm (P < 0.001), and coexisting periampullary diseases (P < 0.001). Using these factors, we developed a risk score model that was validated by considering the pancreatic fistula rate. The overall and clinically relevant pancreatic fistula rate increased with increasing score values (P = 0.002 and P = 0.028, respectively). Using a score cut-off value of six points, patients with a score ≥6 were considered to be at high risk.
  
  
  CONCLUSIONS
  Body mass index >24 kg/m(2), a Wirsung duct size <3 mm, and preoperative diagnosis represented the preoperative factors related to a soft pancreas. These factors proved useful in the building of a risk score model to predict the incidence of pancreatic fistula.
authors.affiliation: Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Chirurgia Generale-Minni, Alma Mater Studiorum, Università di Bologna, Policlinico S. Orsola-Malpighi, Via Massarenti n.9, 40138, Bologna, Italy, riccardo.casadei@aosp.bo.it.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Casadei
authors.forename: Claudio
authors.initials: C
authors.lastname: Ricci
authors.forename: Giovanni
authors.initials: G
authors.lastname: Taffurelli
authors.forename: Marielda
authors.initials: M
authors.lastname: D'Ambra
authors.forename: Carlo Alberto
authors.initials: CA
authors.lastname: Pacilio
authors.forename: Carlo
authors.initials: C
authors.lastname: Ingaldi
authors.forename: Francesco
authors.initials: F
authors.lastname: Minni
mesh_terms: D000368:Aged; D015992:Body Mass Index; D005260:Female; D005544:Forecasting; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000473:pathology*; D010180:Pancreatectomy; D010183:Pancreatic Ducts / Q000473:pathology; D010185:Pancreatic Fistula / Q000209:etiology*; D057234:Preoperative Period; D012189:Retrospective Studies; D012307:Risk Factors