Abstract:
BACKGROUND:Latent pancreatic fistula (LPF) is difficult to diagnose during the early postoperative phase because of initially normal drain fluid amylase (DFA) levels. The present study investigated the clinical significance and risk factors of LPF after pancreatoduodenectomy. METHODS:A total of 662 patients who underwent pancreatoduodenectomy between 2010 and 2018 were retrospectively analyzed. LPF was defined as pancreatic fistula that developed later regardless of initially low DFA levels. RESULTS:Among the 372 patients with DFA ≤375 U/L (three times the upper limit for serum) on postoperative day (POD) 3, LPF occurred in 37 (10%). The rates of postoperative hemorrhaging (11% vs 1.5%), intraabdominal abscess (57% vs 7.2%) and reintervention (46% vs 2.7%) were significantly higher in the patients with LPF than in those without LPF. A multivariate analysis revealed that a body mass index ≥25 kg/m2 , a non-combined portal vein resection, a DFA on POD 1 ≥650 U/L and a C-reactive protein level on POD 3 ≥11 mg/dL were independent risk factors for LPF. CONCLUSIONS:Latent pancreatic fistula was significantly associated with severe complications and worse outcomes after pancreatoduodenectomy. Early drain removal may be unfavorable for patients with some of these risk factors.
journal_name
J Hepatobiliary Pancreat Scijournal_title
Journal of hepato-biliary-pancreatic sciencesauthors
Ohgi K,Yamamoto Y,Sugiura T,Okamura Y,Ito T,Ashida R,Uesaka Kdoi
10.1002/jhbp.820subject
Has Abstractpub_date
2020-12-01 00:00:00pages
1002-1010issue
12eissn
1868-6974issn
1868-6982journal_volume
27pub_type
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