title: Prediction of Pancreatic Fistula by Preoperatively Assessable Factors; Retrospective Review of Unified Operations by Single Surgeon.
abstract: OBJECTIVE
  This retrospective study was conducted to find preoperatively assessable risk factors for postoperative pancreatic fistula (POPF) in patients undergoing laparoscopic distal pancreatectomy (LDP) using a slow compression method with a stapler, which we call pen-firing compression (PFC).
  
  
  METHODS
  Fifty-two patients underwent LDP, of whom 42 underwent PFC for pancreatic division using a stapler. The relationship between preoperatively assessable factors and the incidence of clinical POPF was statistically analyzed.
  
  
  RESULTS
  Overall rate of POPF was 7.1% in 42 patients. Univariate analysis showed that greater BMI (p = 0.004) and thicker pancreatic stump (0.0022) were significant risk factors for POPF. BMI and stump thickness remained significant (P < 0.0001, P < 0.0001) by multivariate analysis. Cutoff points estimated by ROC curve were 27 kg/m2 for BMI and 27 mm for stump thickness.
  
  
  CONCLUSIONS
  High BMI value and thick pancreatic stump are significant risk factors for POPF after LDP. Alternative treatment of the pancreatic stump may prevent POPF in high-risk patients.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Nakamura
authors.forename: Koji
authors.initials: K
authors.lastname: Shindo
authors.forename: Noboru
authors.initials: N
authors.lastname: Ideno
authors.forename: Junji
authors.initials: J
authors.lastname: Ueda
authors.forename: Shunichi
authors.initials: S
authors.lastname: Takahata
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nakashima
authors.forename: Takao
authors.initials: T
authors.lastname: Ohtsuka
authors.forename: Shuji
authors.initials: S
authors.lastname: Shimizu
authors.forename: Yoshinao
authors.initials: Y
authors.lastname: Oda
authors.forename: Masao
authors.initials: M
authors.lastname: Tanaka
mesh_terms: D000328:Adult; D000368:Aged; D019540:Area Under Curve; D015992:Body Mass Index; D016009:Chi-Square Distribution; D004867:Equipment Design; D006801:Humans; D007564:Japan; D010535:Laparoscopy / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010180:Pancreatectomy / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D010185:Pancreatic Fistula / Q000175:diagnosis / Q000209:etiology*; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013528:Surgical Staplers; D017792:Surgical Stapling / Q000009:adverse effects / Q000295:instrumentation; D016896:Treatment Outcome