Risk factors influencing pancreatic leakage and the mortality after pancreaticoduodenectomy in a medium-volume hospital
Fujino, Y.; Suzuki, Y.; Ajiki, T.; Tanioka, Y.; Ku, Y.; Kuroda, Y.
Hepato-Gastroenterology 49(46): 1124-1129
2002
ISSN/ISBN: 0172-6390 PMID: 12143218 Document Number: 550290
Background/Aims: This study was designed to evaluate risk factors influencing pancreatic leakage and pancreatic leakage-related mortality in a medium-volume hospital. Methodology: We retrospectively reviewed the clinical records of 107 patients who underwent pancreaticoduodenectomy at the Kobe University Hospital. Fourteen predictive factors for pancreatic leakage and the pancreatic leakage-related mortality were evaluated using univariate and multivariate logistic regression models. Results: In univariate analysis, the degree of pancreatic fibrosis, type of resection (PD/PPPD), anastomosis techniques (invagination or duct-to-mucosa anastomosis), anastomosis sites (jejunum/stomach), and the presence of congestion in anastomosis sites significantly influenced pancreatic leakage, and the degree of pancreatic fibrosis influenced pancreatic leakage-related mortality. Multivariate logistic regression analysis revealed that congestion in anastomosis sites was the strongest parameter for pancreatic leakage. Univariate analysis of the patients with normal/mild fibrosing pancreas revealed that pancreatic leakage was influenced by type of resection, anastomosis techniques, anastomosis sites, congestion in anastomosis sites and the management of pancreas parenchyma. Conclusions: In a medium-volume hospital, reconstruction after pancreaticoduodenectomy should be performed with careful attention to pancreas and anastomosis sites. In the patients with normal/mild fibrosing pancreas, duct-to-mucosa anastomosis without suturing the pancreas parenchyma may be a useful technique for reconstruction.