Seiko Hirono1, Toshio Shimokawa2, Yuichi Nagakawa3, Yi-Ming Shyr4, Manabu Kawai1, Ippei Matsumoto5, Sohei Satoi6, Hideyuki Yoshitomi7, Takehiro Okabayashi8, Fuyuhiko Motoi9, Ryosuke Amano10, Yoshiaki Murakami11, Satoshi Hirano12, Kazuyuki Kawamoto13, Shoji Nakamori14, Yan-Shen Shan15, Shinjiro Kobayashi16, Hiroyuki Nitta17, Hiroyoshi Matsukawa18, Kazuhisa Uchiyama19, Chih-Po Hsu20, Chie Kitami21, Masakazu Yamamoto22, Tsann-Long Hwang20, Hiroki Yamaue1. 1. Second Department of Surgery, Wakayama Medical University, School of Medicine, Wakayama, Japan. 2. Clinical Study Support Center, Wakayama Medical University, School of Medicine, Wakayama, Japan. 3. Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan. 4. Department of Surgery, Taipei Veterans General Hospital, National Yang Ming University, Taipei, Taiwan. 5. Department of Surgery, Kindai University, Faculty of Medicine, Osaka, Japan. 6. Department of Surgery, Kansai Medical University, Osaka, Japan. 7. Department of General Surgery, Chiba University, Graduate School of Medicine, Chiba, Japan. 8. Division of Hepato-Biliary Pancreatic Surgery, Kochi Health Sciences Center, Kochi, Japan. 9. Department of Surgery, Tohoku University, Graduate School of Medicine, Miyagi, Japan. 10. Department of Surgical Oncology, Osaka City University, Graduate School of Medicine, Osaka, Japan. 11. Department of Surgery, Hiroshima University, Hiroshima, Japan. 12. Department of Gastroenterological Surgery II, Hokkaido University, Faculty of Medicine, Hokkaido, Japan. 13. Department of Surgery, Kurashiki Central Hospital, Okayama, Japan. 14. Department of Surgery, Osaka National Hospital, Osaka, Japan. 15. Department of Surgery, National Cheng-Kung University Hospital, Institute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan. 16. Division of Gastroenterological and General Surgery, St. Marianna University School of Medicine, Kanagawa, Japan. 17. Department of Surgery, Iwate Medical University, School of Medicine, Iwate, Japan. 18. Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan. 19. Department of Surgery, Osaka Medical College, Osaka, Japan. 20. Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Linkou, Taoyuan City, Taiwan. 21. Department of Surgery, Nagaoka Chuo General Hospital, Niigata, Japan. 22. Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.
Abstract
BACKGROUND: Grade C postoperative pancreatic fistula (POPF), as defined by International Study Group of Pancreatic Fistula (ISGPF), is the most life-threatening complication after pancreatoduodenectomy (PD). This study aims to evaluate risk factors for Grade C POPF after PD. METHODS: This is a prospective, multicenter study based in Japan and Taiwan. Between December 2014 and May 2017, 3,022 patients were enrolled in this study and 2,762 patients were analyzed. We analyzed risk factors of Grade C POPF based on the updated 2016 ISGPF scheme (organ failure, reoperation, and/or death). RESULTS: Among 2,762 patients, 46 patients (1.7%) developed Grade C POPF after PD. The mortality rate of the 46 patients with Grade C POPF was 37.0%. On the multivariate analysis, six independent risk factors for Grade C POPF were found; BMI ≥25.0 kg/m2 , chronic steroid use, preoperative serum albumin <3.0 mg/dl, soft pancreas, operative time ≥480 min, and intraoperative transfusion. The c-statistic of our risk scoring model for Grade C POPF using these risk factors was 0.77. The score was significantly higher in Grade C POPF than in Grade B POPF (P<0.001) or none/biochemical leak (P<0.001). CONCLUSIONS: This prospective study showed risk factors for Grade C POPF after PD. This article is protected by copyright. All rights reserved.
BACKGROUND: Grade C postoperative pancreatic fistula (POPF), as defined by International Study Group of Pancreatic Fistula (ISGPF), is the most life-threatening complication after pancreatoduodenectomy (PD). This study aims to evaluate risk factors for Grade C POPF after PD. METHODS: This is a prospective, multicenter study based in Japan and Taiwan. Between December 2014 and May 2017, 3,022 patients were enrolled in this study and 2,762 patients were analyzed. We analyzed risk factors of Grade C POPF based on the updated 2016 ISGPF scheme (organ failure, reoperation, and/or death). RESULTS: Among 2,762 patients, 46 patients (1.7%) developed Grade C POPF after PD. The mortality rate of the 46 patients with Grade C POPF was 37.0%. On the multivariate analysis, six independent risk factors for Grade C POPF were found; BMI ≥25.0 kg/m2 , chronic steroid use, preoperative serum albumin <3.0 mg/dl, soft pancreas, operative time ≥480 min, and intraoperative transfusion. The c-statistic of our risk scoring model for Grade C POPF using these risk factors was 0.77. The score was significantly higher in Grade C POPF than in Grade B POPF (P<0.001) or none/biochemical leak (P<0.001). CONCLUSIONS: This prospective study showed risk factors for Grade C POPF after PD. This article is protected by copyright. All rights reserved.
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Keywords:
Grade C POPF; mortality; pancreatic fistula; pancreatoduodenectomy; risk factor