title: Analysis of risk factors for postoperative pancreatic fistula following pancreaticoduodenectomy.
abstract: OBJECTIVE
  To explore the morbidity and risk factors of postoperative pancreatic fistula (POPF) following pancreaticoduodenectomy.
  
  
  METHODS
  The data from 196 consecutive patients who underwent pancreaticoduodenectomy, performed by different surgeons, in the General Hospital of the People's Liberation Army between January 1(st), 2013 and December 31(st), 2013 were retrospectively collected for analysis. The diagnoses of POPF and clinically relevant (CR)-POPF following pancreaticoduodenectomy were judged strictly by the International Study Group on Pancreatic Fistula Definition. Univariate analysis was performed to analyze the following factors: patient age, sex, body mass index (BMI), hypertension, diabetes mellitus, serum CA19-9 level, history of jaundice, serum albumin level, blood loss volume, pancreatic duct diameter, pylorus preserving pancreaticoduodenectomy, pancreatic drainage and pancreaticojejunostomy. Multivariate logistic regression analysis was used to determine the main independent risk factors for POPF.
  
  
  RESULTS
  POPF occurred in 126 (64.3%) of the patients, and the incidence of CR-POPF was 32.7% (64/196). Patient characteristics of age, sex, BMI, hypertension, diabetes mellitus, serum CA19-9 level, history of jaundice, serum albumin level, blood loss volume, pylorus preserving pancreaticoduodenectomy and pancreaticojejunostomy showed no statistical difference related to the morbidity of POPF or CR-POPF. Pancreatic duct diameter was found to be significantly correlated with POPF rates by univariate analysis and multivariate regression analysis, with a pancreatic duct diameter ≤ 3 mm being an independent risk factor for POPF (OR = 0.291; P = 0.000) and CR-POPF (OR = 0.399; P = 0.004). The CR-POPF rate was higher in patients without external pancreatic stenting, which was found to be an independent risk factor for CR-POPF (OR = 0.394; P = 0.012). Among the entire patient series, there were three postoperative deaths, giving a total mortality rate of 1.5% (3/196), and the mortality associated with pancreatic fistula was 2.4% (3/126).
  
  
  CONCLUSIONS
  A pancreatic duct diameter ≤ 3 mm is an independent risk factor for POPF. External stent drainage of pancreatic secretion may reduce CR-POPF mortality and POPF severity.
authors.affiliation: Qi-Yu Liu, Department of Hepatobiliary Surgery, the First People's Hospital of Kunming, Kunming 650031, Yunnan Province, China.
authors.forename: Qi-Yu
authors.initials: QY
authors.lastname: Liu
authors.affiliation: Qi-Yu Liu, Department of Hepatobiliary Surgery, the First People's Hospital of Kunming, Kunming 650031, Yunnan Province, China.
authors.forename: Wen-Zhi
authors.initials: WZ
authors.lastname: Zhang
authors.affiliation: Qi-Yu Liu, Department of Hepatobiliary Surgery, the First People's Hospital of Kunming, Kunming 650031, Yunnan Province, China.
authors.forename: Hong-Tian
authors.initials: HT
authors.lastname: Xia
authors.affiliation: Qi-Yu Liu, Department of Hepatobiliary Surgery, the First People's Hospital of Kunming, Kunming 650031, Yunnan Province, China.
authors.forename: Jian-Jun
authors.initials: JJ
authors.lastname: Leng
authors.affiliation: Qi-Yu Liu, Department of Hepatobiliary Surgery, the First People's Hospital of Kunming, Kunming 650031, Yunnan Province, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Wan
authors.affiliation: Qi-Yu Liu, Department of Hepatobiliary Surgery, the First People's Hospital of Kunming, Kunming 650031, Yunnan Province, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Liang
authors.affiliation: Qi-Yu Liu, Department of Hepatobiliary Surgery, the First People's Hospital of Kunming, Kunming 650031, Yunnan Province, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Yang
authors.affiliation: Qi-Yu Liu, Department of Hepatobiliary Surgery, the First People's Hospital of Kunming, Kunming 650031, Yunnan Province, China.
authors.forename: Jia-Hong
authors.initials: JH
authors.lastname: Dong
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D002681:China; D004322:Drainage / Q000295:instrumentation; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010183:Pancreatic Ducts / Q000473:pathology / Q000601:surgery*; D010185:Pancreatic Fistula / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015607:Stents; D016896:Treatment Outcome
keywords: Complication; Pancreatic duct; Pancreatic fistula; Pancreaticoduodenectomy