title: Body Surface Area: A new predictive factor of mortality and pancreatic fistula after pancreaticoduodenectomy: A cohort-study.
abstract: BACKGROUND
  To assess the role of Body Surface Area (BSA) in predicting pancreatic fistula and mortality after pancreaticoduodenectomy.
  
  
  METHODS
  The data of patients who underwent pancreaticoduodenectomy between January 1992 to December 2012 at the University Hospital of Caen were collected prospectively and analyzed retrospectively. Pancreatic fistula was determined according to the ISPGF (International Study Group for Pancreatic Fistula) criteria. The Clavien and Dindo classification was used for grading post-operative complications and BSA was calculated according to the Boyd formula. Patients were classified as "large" and "non-large" using a BSA value ≥1.82 to define the large group and the non-large group. The primary end points were post-operative mortality rate, and the rate and grade of post-operative pancreatic fistula.
  
  
  RESULTS
  411 patients underwent pancreaticoduodenectomy with a mean age of 61.2 (±12.1) year. Six patients (1.45%) died post-operatively. Patients with a BSA ≥1.82 had a significantly higher risk of post-operative death: OR 3.55 [1.43-8.80] (p < 0.0005). Eighty-five patients (20.7%) developed a post-operative pancreatic fistulas. The grade A pancreatic fistula rate was 87.1%. Patients with a BSA ≥1.82 had a significantly higher risk of developing overall post-operative pancreatic fistula (p < 0.038). Multivariate analysis showed that "large" patients (1.86, 95%CI[1.09-3.92], p = 0.0229), soft pancreas (6.5, 95%CI[2.39-9.31], p = 0.0155) and a BMI ≥ 25 (1.09, 95%CI[1.031-1.163], p = 0.0407) were independent risk factors of pancreatic fistula.
  
  
  CONCLUSIONS
  Body Surface Area is a useful factor after pancreaticoduodenectomy to predict mortality and post-operative fistula.
authors.affiliation: Department of Digestive Surgery, University Hospital of Caen, Avenue de la Côte de Nacre, 14033 Caen Cedex, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Menahem
authors.affiliation: Department of Digestive Surgery, University Hospital of Caen, Avenue de la Côte de Nacre, 14033 Caen Cedex, France.
authors.forename: Andrea
authors.initials: A
authors.lastname: Mulliri
authors.affiliation: Department of Histopathology, University Hospital of Caen, 14033 Caen Cedex, France.
authors.forename: Céline
authors.initials: C
authors.lastname: Bazille
authors.affiliation: Department of Digestive Surgery, University Hospital of Tours, 37044 Tours Cedex 9, France.
authors.forename: Ephrem
authors.initials: E
authors.lastname: Salame
authors.affiliation: Department of Biostatistics and Clinical Research, University Hospital of Caen, 14033 Caen Cedex, France.
authors.forename: Rémy
authors.initials: R
authors.lastname: Morello
authors.affiliation: Department of Digestive Surgery, University Hospital of Caen, Avenue de la Côte de Nacre, 14033 Caen Cedex, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Alves
authors.affiliation: Department of Digestive Surgery, University Hospital of Bordeaux, Avenue de Magellan, 33600 Pessac, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Chiche
authors.affiliation: Department of Digestive Surgery, University Hospital of Caen, Avenue de la Côte de Nacre, 14033 Caen Cedex, France. Electronic address: lubrano-j@chu-caen.fr.
authors.forename: Jean
authors.initials: J
authors.lastname: Lubrano
mesh_terms: D001830:Body Surface Area; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000601:surgery; D010185:Pancreatic Fistula / Q000175:diagnosis / Q000209:etiology / Q000401:mortality*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate
keywords: Body Surface Area; Pancreatic fistula; Pancreaticoduodenectomy