Yayoi Matsumoto, Saiho Ko*, Tadataka Takagi, Yuuki Kirihataya, Yasuyuki Nakata, Masanori Matsusaka, Tomohide Mukogawa, Hirofumi Ishikawa and Akihiko Watanabe
Department of Surgery, Nara Prefecture General Medical Center, JapanFulltext PDF
Background: Pancreatic fistula (PF) is a potentially life-threatening postoperative complication after pancreatoduodenectomy (PD). Soft pancreatic texture is known to be a risk factor of PF. The study tried to elucidate risk factors of PF, especially in patients with soft pancreas.Methods: One hundred-nine patients underwent PD between 2010 and 2014, excluding cases of PD with major hepatectomy. The diagnoses were: pancreatic carcinoma in 44, cholangiocarcinoma in 23, and carcinoma of the Vater’s papilla in 14 and others in 28 patients. Principally, pancreatic duct stent was placed through the duct-to-mucosal pancreatojejunostomy only in patients with soft pancreas and small diameter of the pancreatic duct. PF was defined and scored based on the criteria of the International Study Group on Pancreatic Fistula. Factors influencing development of PF Grade B/C were analyzed. As potential risk factors, age, sex, diagnosis, pancreatic texture, diameter of pancreatic duct, use of pancreatic duct stent, device of dividing the pancreas, blood loss, operation time, and preoperative biliary drainage were included for univariate and multivariate analyses.Results: PF Grades B and C developed in 8 and 2 patients, respectively. Eight of these patients had soft pancreas. No significant risk factors were determined in the analysis of all patients (n=109). However, small pancreatic duct (≦3mm; p=0.026), non-pancreatic carcinoma patients (p=0.0114), and smaller amount of blood loss (<1000ml; p<0.0001) were independent risk factors of PF Grade B/C in patients with soft pancreas (n=68).Conclusions: Soft pancreas was not a risk factor of PF, probably because of standard use of pancreatic duct stent. Small pancreatic duct, non-pancreatic carcinoma, and the amount of blood loss were significant risk factors of PF in patients with soft pancreas.
Pancreatic fistula; Pancreatoduodenectomy; Soft pancreas; Pancreatic duct stent
Matsumoto Y, Ko S, Takagi T, Kirihataya Y, Nakata Y, Matsusaka M, et al. Risk Factor of Pancreatic Fistula after Pancreatoduodenectomy in Patients with Soft Pancreas. Clin Surg. 2016; 1: 1092.