title: Pancreatoduodenectomy: Risk Factors of Postoperative Pancreatic Fistula.
abstract: OBJECTIVE
  The aim of the present study is the analysis of risk factors of postoperative pancreatic fistula (POPF) and of clinical outcome after pancreatoduodenectomy (PD) in a retrospective multicentric review of the patient cohort.
  
  
  METHODS
  From January 2003 to July 2013 143 patients underwent PD: 138 cases were included and 3 groups were identified according to the different types of anastomosis: Group 1 invaginating end-to-end pancreatojejunostomy, Group 2 end-to-side pancreatojejunostomy with duct-to-mucosa anastomosis, Group 3 end-to-side pancreatogastrostomy.
  
  
  RESULTS
  Twenty-one % of patients developed POPF, 16% in Group 1, 27% in Group 2, 12% in Group 3. Forty % grade A, 13% grade B and 47% grade C total POPF. It results that POPF occurred in 16% of hard and in 40% of soft pancreatic texture; in 11.4% of dilated Wirsung versus 30.8% of non dilated (p = 0.007). Overall actuarial 1 and 3 year survival after PD is 69% and 48% respectively. Perioperative mortality is 5.8% overall, 17.85% for grade C.
  
  
  CONCLUSIONS
  No differences have been found among surgical anastomosis techniques. Soft tissues seem to increase, while dilated Wirsung seems to decrease POPF rate. The development of POPF increase morbidity but it doesn't affect overall survival, more strictly related to tumour histopathology.
authors.forename: Luciano Gregorio
authors.initials: LG
authors.lastname: De Carlis
authors.forename: Raffaella
authors.initials: R
authors.lastname: Sguinzi
authors.forename: Fabio
authors.initials: F
authors.lastname: Ferla
authors.forename: Stefano
authors.initials: S
authors.lastname: Di Sandro
authors.forename: Bogdan M
authors.initials: BM
authors.lastname: Dorobantu
authors.forename: Riccardo
authors.initials: R
authors.lastname: De Carlis
authors.forename: Caterina
authors.initials: C
authors.lastname: Cusumano
authors.forename: Alessandro
authors.initials: A
authors.lastname: Giacomoni
authors.forename: Charles
authors.initials: C
authors.lastname: Ferrari
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008984:Monaco; D010182:Pancreatic Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D010185:Pancreatic Fistula / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome