title: Surgical Results of Pancreaticoduodenectomy for Pancreatic Ductal Adenocarcinoma: a Multi-institutional Retrospective Study of 174 patients.
abstract: BACKGROUND
  Postoperative pancreatic fistula (POPF) remains a major complication after pancreaticoduodenectomy (PD), and the prognosis of patients with pancreatic ductal adenocarcinoma (PDAC) after PD is poor.
  
  
  METHODS
  A multi-institutional retrospective study was performed in 174 patients who underwent PD for PDAC from 2007 to 2012. The details of clinical data were examined, and risk factors for POPF and poor prognostic factors after PD were identified.
  
  
  RESULTS
  POPF occured in 26 patients (15%), and 18 patients (10%) were diagnosed as Grade B/C POPF. The independent risk factors for Grade B/C POPF were body mass index (BMI) ≥25 (Odds Ratio [OR]=21.1, p=0.006) and absence of post-operative enteral nutrition (EN) (OR=10.2, p=0.04). The 1-, 3-, and 5-year overall survivals of patients with PDAC after PD were 76%, 35%, and 18%, respectively. R1/2 operation was identified as the only independent poor prognostic factor (Hazard Ratio=3.66; p=0.0002).
  
  
  CONCLUSIONS
  Patients with BMI ≥25 should be closely monitored for POPF after PD. Post-operative EN might help prevent POPF. Performing R0 resection is an important goal for ensuring patient survival after PD for PDAC.
authors.affiliation: Department of Hepato-Biliary-Pancreatic Surgery, National Kyushu Cancer Center, Fukuoka, Japan yamashi@surg2.med.kyushu-u.ac.jp.
authors.forename: Yo-Ichi
authors.initials: Y
authors.lastname: Yamashita
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan.
authors.forename: Tomoharu
authors.initials: T
authors.lastname: Yoshizumi
authors.affiliation: Department of Surgery, Oita Red Cross Hospital, Oita, Japan.
authors.forename: Kengo
authors.initials: K
authors.lastname: Fukuzawa
authors.affiliation: Department of Surgery, Matsuyama Red Cross Hospital, Matsuyama, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Nishizaki
authors.affiliation: Department of Hepato-Biliary-Pancreatic Surgery, National Kyushu Cancer Center, Fukuoka, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Tsujita
authors.affiliation: Department of Surgery, Iizuka Hospital, Iizuka, Japan.
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Kajiyama
authors.affiliation: Department of Surgery, Saiseikai Fukuoka General Hospital, Fukuoka, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Soejima
authors.affiliation: Department of Surgery, Saiseikai Karatsu Hospital, Karatsu, Japan.
authors.forename: Motoyuki
authors.initials: M
authors.lastname: Yamagata
authors.affiliation: Department of Surgery, Munakata Medical Association Hospital, Munakata, Japan.
authors.forename: Kazuharu
authors.initials: K
authors.lastname: Yamamoto
authors.affiliation: Department of Surgery, Oita Prefectural Hospital, Oita, Japan.
authors.forename: Eisuke
authors.initials: E
authors.lastname: Adachi
authors.affiliation: Department of Surgery, Steal Memorial Yawata Hospital, Kitakyushu, Japan.
authors.forename: Keishi
authors.initials: K
authors.lastname: Sugimachi
authors.affiliation: Department of Surgery, Fukuoka Higashi Medical Center, Koga, Japan.
authors.forename: Yasuharu
authors.initials: Y
authors.lastname: Ikeda
authors.affiliation: Department of Surgery, Fukuoka City Hospital, Fukuoka, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Uchiyama
authors.affiliation: Department of Surgery, Hiroshima Red Cross Hospital and AtomicBomb Survivors Hospital, Hiroshima, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Maeda
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Itoh
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan.
authors.forename: Norifumi
authors.initials: N
authors.lastname: Harimoto
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Ikegami
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan.
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Maehara
mesh_terms: D000368:Aged; D021441:Carcinoma, Pancreatic Ductal / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Pancreaticoduodenectomy; multi-institutional study; overall survival; pancreatic ductal adenocarcinoma; postoperative pancreatic fistula