Rungsakulkij N, Mingphruedhi S, Tangtawee P, Krutsri C, Muangkaew P, Suragul W, Tannaphai P, Aeesoa S. Risk factors for pancreatic fistula following pancreaticoduodenectomy: A retrospective study in a Thai tertiary center. World J Gastrointest Surg 2017; 9(12): 270-280 [PMID: 29359033 DOI: 10.4240/wjgs.v9.i12.270]
Corresponding Author of This Article
Narongsak Rungsakulkij, MD, FRCS (Gen Surg), Lecturer, Surgeon, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Ramathibodi Hospital, 270 Praram VI road, Ratchathewi, Bangkok 10400, Thailand. narongsak.run@mahidol.ac.th
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Clinical Practice Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Narongsak Rungsakulkij, Somkit Mingphruedhi, Pongsatorn Tangtawee, Chonlada Krutsri, Paramin Muangkaew, Wikran Suragul, Suraida Aeesoa, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
Penampai Tannaphai, Department of Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
Author contributions: Rungsakulkij N contributed to design of the work, data collection, interpretation of data, writing and drafting the work; Mingphruedhi S, Tangtawee P and Krutsri C contributed to data collection and analysis; Muangkaew P, Suragul W and Tannapai P contributed to data collection; Aeesoa S contributed to data analysis.
Institutional review board statement: The study was reviewed and approved by the Ramathibodi Hospital Institutional Review Board Committee on Human Rights Related to Research Involving Human Subjects. The protocol number is ID 12-59-50.
Informed consent statement: Not applicable.
Conflict-of-interest statement: All authors have no conflict of interest to report.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Narongsak Rungsakulkij, MD, FRCS (Gen Surg), Lecturer, Surgeon, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Ramathibodi Hospital, 270 Praram VI road, Ratchathewi, Bangkok 10400, Thailand. narongsak.run@mahidol.ac.th
Telephone: +66-2-2011527 Fax: +66-2-2012471
Received: July 24, 2017 Peer-review started: July 26, 2017 First decision: September 11, 2017 Revised: September 15, 2017 Accepted: October 30, 2017 Article in press: October 30, 2017 Published online: December 27, 2017 Processing time: 155 Days and 19.1 Hours
Abstract
AIM
To analyze the risk factors of postoperative pancreatic fistula following pancreaticoduodenectomy in a Thai tertiary care center.
METHODS
We retrospectively analyzed 179 patients who underwent pancreaticoduodenectomy at our hospital from January 2001 to December 2016. Pancreatic fistula were classified into three categories according to a definition made by an International Study Group on Pancreatic Fistula. The risk factors for pancreatic fistula were analyzed by univariate analysis and multivariate logistic regression analysis.
RESULTS
Pancreatic fistula were detected in 88/179 patients (49%) who underwent pancreaticoduodenectomy. Fifty-eight pancreatic fistula (65.9%) were grade A, 22 cases (25.0%) were grade B and eight cases (9.1%) were grade C. Clinically relevant pancreatic fistula were detected in 30/179 patients (16.7%). The 30-d mortality rate was 1.67% (3/179 patients). Multivariate logistic regression analysis revealed that soft pancreatic texture (odds ratio = 3.598, 95%CI: 1.77-7.32) was the most significant risk factor for pancreatic fistula. A preoperative serum bilirubin level of > 3 mg/dL was the most significant risk factor for clinically relevant pancreatic fistula according to univariate and multivariate analysis.
CONCLUSION
Soft pancreatic tissue is the most significant risk factor for postoperative pancreatic fistula. A high preoperative serum bilirubin level (> 3 mg/dL) is the most significant risk factor for clinically relevant pancreatic fistula.
Core tip: Pancreaticoduodenectomy is a high morbidity operation. The most common perioperative complication is postoperative pancreatic fistula. We retrospectively analyzed 179 patients who underwent pancreaticoduodenectomy at our hospital. We found that soft pancreatic tissue is the most significant risk factor for postoperative pancreatic fistula. A high preoperative serum bilirubin level (> 3 mg/dL) is the most significant risk factor for clinically relevant pancreatic fistula.
