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World Journal of Surgery

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01-12-2009

How Do We Predict the Clinically Relevant Pancreatic Fistula After Pancreaticoduodenectomy?—An Analysis in 244 Consecutive Patients

Authors: Manabu Kawai, Masaji Tani, Seiko Hirono, Shinomi Ina, Motoki Miyazawa, Hiroki Yamaue

Published in: World Journal of Surgery | Issue 12/2009

Abstract

Background

The most important problem in pancreatic fistula is whether one can distinguish clinical pancreatic fistula, grade B + C fistula by the International Study Group on Pancreatic Fistula (ISGPF), from transient pancreatic fistula (grade A), in the early period after pancreaticoduodenectomy (PD). It remains unclear what predictive risk factors can precisely predict which clinical relevant or transient pancreatic fistula when diagnosed pancreatic fistula on POD3 by ISGPF criteria.

Methods

We analyzed the predictive factors of clinical pancreatic fistula by logistic regression analysis in 244 consecutive patients who underwent PD. Pancreatic fistula was classified into three categories by ISGPF.

Results

The rate of pancreatic fistula was 69 of 244 consecutive patients (28%) who underwent PD. Of these, 47 (19%) had grade A by ISGPF criteria, 17 patients (7.0%) had grade B, and five patients (2.0%) had grade C. The independent risk factor of incidence of pancreatic fistula is soft pancreatic parenchyma. However, soft pancreatic parenchyma did not predict underlying clinically relevant pancreatic fistula. The independent predictive factors of clinically relevant pancreatic fistula were serum albumin level ≤3.0 g/dl on postoperative day (POD) 4 and leukocyte counts >9,800 mm⁻³ on POD 4. Positive predictive value of the combination of two predictive factors for clinical relevant pancreatic fistula was 88%.

Conclusions

The combination of two factors on POD4, serum albumin level ≤3.0 g/dl and leukocyte counts >9,800 mm⁻³, is predictive of clinical relevant pancreatic fistula when diagnosed pancreatic fistula on POD 3 by ISGPF criteria.

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Title: How Do We Predict the Clinically Relevant Pancreatic Fistula After Pancreaticoduodenectomy?—An Analysis in 244 Consecutive Patients
Authors: Manabu Kawai
Masaji Tani
Seiko Hirono
Shinomi Ina
Motoki Miyazawa
Hiroki Yamaue
Publication date: 01-12-2009
Publisher: Springer-Verlag
Published in: World Journal of Surgery / Issue 12/2009
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-009-0220-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

How Do We Predict the Clinically Relevant Pancreatic Fistula After Pancreaticoduodenectomy?—An Analysis in 244 Consecutive Patients

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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