Risk Factors of Pancreatic Fistula after Pancreaticoduodenectomy - Patients with Low Drain Amylase Level on Postoperative Day 1 are Safe from Developing Pancreatic Fistula

Background/Aims: Based on the criteria of International Study Group on Pancreatic Fistula (ISGPF), the risk factors for grade B/C pancreatic fistula (PF) after pancreaticoduodenectomy (PD) were analyzed in this study. Methodology: Between October 2006 and August 2010, 114 consecutive patients underwent PD at National Hospital Organization Osaka National Hospital. We compared the clinicopathological features between patients with grade B/C PF and those with PF-free/grade A PE We also examined the relationship between PF formation and the drain amylase level on post-operative day (POD) 1 and POD 3. Results: Eighteen patients (15.8%) developed grade B/C PE Of these patients, four patients underwent reoperation. The mortality rate in patients with grade B/C PF was 5.6% (1/18). The non-dilated pancreatic duct (<= 3mm) was the only independent risk factor for grade B/C PF by a multivariate analysis (p=0.026). There were 45 patients who showed low (<= three times serum amylase level) drain amylase level on POD 1 and none of them developed PE Conclusions: Although our study demonstrated that the non-dilated pancreatic duct is significantly correlated with the increased incidence of grade B/C PF, patients with low amylase level of drainage fluid on POD 1 are thought to be safe from developing PF.