Risk factors for pancreatic fistula grade C after pancreatoduodenectomy: A large prospective, multicenter Japan-Taiwan collaboration study

被引：33

作者：

Hirono, Seiko ^{[1
]}

Shimokawa, Toshio ^{[2
]}

Nagakawa, Yuichi ^{[3
]}

Shyr, Yi-Ming ^{[4
]}

Kawai, Manabu ^{[1
]}

Matsumoto, Ippei ^{[5
]}

Satoi, Sohei ^{[6
]}

Yoshitomi, Hideyuki ^{[7
]}

Okabayashi, Takehiro ^{[8
]}

Motoi, Fuyuhiko ^{[9
]}

Amano, Ryosuke ^{[10
]}

Murakami, Yoshiaki ^{[11
]}

Hirano, Satoshi ^{[12
]}

Kawamoto, Kazuyuki ^{[13
]}

Nakamori, Shoji ^{[14
]}

Shan, Yan-Shen ^{[15
]}

Kobayashi, Shinjiro ^{[16
]}

Nitta, Hiroyuki ^{[17
]}

Matsukawa, Hiroyoshi ^{[18
]}

Uchiyama, Kazuhisa ^{[19
]}

Hsu, Chih-Po ^{[20
]}

Kitami, Chie ^{[21
]}

Yamamoto, Masakazu ^{[22
]}

Hwang, Tsann-Long ^{[20
]}

Yamaue, Hiroki ^{[1
]}

机构：

[1] Wakayama Med Univ, Sch Med, Dept Surg 2, 811-1 Kimiidera, Wakayama 6418510, Japan

[2] Wakayama Med Univ, Clin Study Support Ctr, Sch Med, Wakayama, Japan

[3] Tokyo Med Univ, Dept Gastrointestinal & Pediat Surg, Tokyo, Japan

[4] Natl Yang Ming Univ, Taipei Vet Gen Hosp, Dept Surg, Taipei, Taiwan

[5] Kindai Univ, Fac Med, Dept Surg, Osaka, Japan

[6] Kansai Med Univ, Dept Surg, Osaka, Japan

[7] Chiba Univ, Grad Sch Med, Dept Gen Surg, Chiba, Japan

[8] Kochi Hlth Sci Ctr, Div Hepatobiliary Pancreat Surg, Kochi, Japan

[9] Tohoku Univ, Grad Sch Med, Dept Surg, Sendai, Miyagi, Japan

[10] Osaka City Univ, Grad Sch Med, Dept Surg Oncol, Osaka, Japan

[11] Hiroshima Univ, Dept Surg, Hiroshima, Japan

[12] Hokkaido Univ, Fac Med, Dept Gastroenterol Surg 2, Sapporo, Hokkaido, Japan

[13] Kurashiki Cent Hosp, Dept Surg, Okayama, Japan

[14] Osaka Natl Hosp, Dept Surg, Osaka, Japan

[15] Natl Cheng Kung Univ, Natl Cheng Kung Univ Hosp, Inst Clin Med, Dept Surg, Tainan, Taiwan

[16] St Marianna Univ, Sch Med, Div Gastroenterol & Gen Surg, Kawasaki, Kanagawa, Japan

[17] Iwate Med Univ, Sch Med, Dept Surg, Morioka, Iwate, Japan

[18] Hiroshima City Hiroshima Citizens Hosp, Dept Surg, Hiroshima, Japan

[19] Osaka Med Coll, Dept Surg, Osaka, Japan

[20] Chang Gung Univ, Chang Gung Mem Hosp, Coll Med, Dept Surg, Taoyuan, Taiwan

[21] Nagaoka Chuo Gen Hosp, Dept Surg, Niigata, Japan

[22] Tokyo Womens Med Univ, Inst Gastroenterol, Tokyo, Japan

来源：

JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES | 2020年 / 27卷 / 09期

关键词：

pancreatoduodenectomy; pancreatic fistula; Grade C POPF; mortality; risk factor; INTERNATIONAL STUDY-GROUP; POSTOPERATIVE COMPLICATIONS; DEFINITION; MORBIDITY; SURGERY; SYSTEM; RATIO; BODY;

D O I：

10.1002/jhbp.799

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

Background/Purpose 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, 3022 patients were enrolled in this study and 2762 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 2762 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/m(2), chronic steroid use, preoperative serum albumin <3.0 mg/dL, soft pancreas, operative time >= 480 minutes, 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 < .001) or none/biochemical leak (P < .001). Conclusions This prospective study showed risk factors for Grade C POPF after PD.

引用

页码：622 / 631

页数：10

共 27 条

[1] Risk factors for postoperative pancreatic fistula after pancreaticoduodenectomy: the significance of the ratio of the main pancreatic duct to the pancreas body as a predictor of leakage [J].

Akamatsu, Nobuhisa ;

Sugawara, Yasuhiko ;

Komagome, Masahiko ;

Shin, Nobuhiro ;

Cho, Narihiro ;

Ishida, Takashi ;

Ozawa, Fumiaki ;

Hashimoto, Daijo .

JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES, 2010, 17 (03) :322-328

[2] Risk factors of serious postoperative complications after pancreaticoduodenectomy and risk calculators for predicting postoperative complications: a nationwide study of 17,564 patients in Japan [J].

Aoki, Shuichi ;

Miyata, Hiroaki ;

Konno, Hiroyuki ;

Gotoh, Mitsukazu ;

Motoi, Fuyuhiko ;

Kumamaru, Hiraku ;

Wakabayashi, Go ;

Kakeji, Yoshihiro ;

Mori, Masaki ;

Seto, Yasuyuki ;

Unno, Michiaki .

JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES, 2017, 24 (05) :243-251

[3] Postoperative pancreatic fistula: An international study group (ISGPF) definition [J].

Bassi, C ;

Dervenis, C ;

Butturini, G ;

Fingerhut, A ;

Yeo, C ;

Izbicki, J ;

Neoptolemos, J ;

Sarr, M ;

Traverso, W ;

Buchler, M .

SURGERY, 2005, 138 (01) :8-13

[4] The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After [J].

Bassi, Claudio ;

Marchegiani, Giovanni ;

Dervenis, Christos ;

Sarr, Micheal ;

Abu Hilal, Mohammad ;

Adham, Mustapha ;

Allen, Peter ;

Andersson, Roland ;

Asbun, Horacio J. ;

Besselink, Marc G. ;

Conlon, Kevin ;

Del Chiaro, Marco ;

Falconi, Massimo ;

Fernandez-Cruz, Laureano ;

Fernandez-Del Castillo, Carlos ;

Fingerhut, Abe ;

Friess, Helmut ;

Gouma, Dirk J. ;

Hackert, Thilo ;

Izbicki, Jakob ;

Lillemoe, Keith D. ;

Neoptolemos, John P. ;

Olah, Attila ;

Schulick, Richard ;

Shrikhande, Shailesh V. ;

Takada, Tadahiro ;

Takaori, Kyoichi ;

Traverso, William ;

Vollmer, Charles ;

Wolfgang, Christopher L. ;

Yeo, Charles J. ;

Salvia, Roberto ;

Buehler, Marcus .

SURGERY, 2017, 161 (03) :584-591

[5] A Prospectively Validated Clinical Risk Score Accurately Predicts Pancreatic Fistula after Pancreatoduodenectomy [J].

Callery, Mark P. ;

Pratt, Wande B. ;

Kent, Tara S. ;

Chaikof, Elliot L. ;

Vollmer, Charles M., Jr. .

JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS, 2013, 216 (01) :1-14

[6] A MECHANISM FOR THE ANTIINFLAMMATORY EFFECTS OF CORTICOSTEROIDS - THE GLUCOCORTICOID RECEPTOR REGULATES LEUKOCYTE ADHESION TO ENDOTHELIAL-CELLS AND EXPRESSION OF ENDOTHELIAL LEUKOCYTE ADHESION MOLECULE-1 AND INTERCELLULAR-ADHESION MOLECULE-1 [J].

CRONSTEIN, BN ;

KIMMEL, SC ;

LEVIN, RI ;

MARTINIUK, F ;

WEISSMANN, G .

PROCEEDINGS OF THE NATIONAL ACADEMY OF SCIENCES OF THE UNITED STATES OF AMERICA, 1992, 89 (21) :9991-9995

[7] Classification of surgical complications - A new proposal with evaluation in a cohort of 6336 patients and results of a survey [J].

Dindo, D ;

Demartines, N ;

Clavien, PA .

ANNALS OF SURGERY, 2004, 240 (02) :205-213

[8] Life-threatening postoperative pancreatic fistula (grade C) after pancreaticoduodenectomy: incidence, prognosis, and risk factors [J].

Fuks, David ;

Piessen, Guillaume ;

Huet, Emmanuel ;

Tavernier, Marion ;

Zerbib, Philippe ;

Michot, Francis ;

Scotte, Michel ;

Triboulet, Jean-Pierre ;

Mariette, Christophe ;

Chiche, Laurence ;

Salame, Ephraim ;

Segol, Philippe ;

Pruvot, Francois-Rene ;

Mauvais, Francois ;

Roman, Horace ;

Verhaeghe, Pierre ;

Regimbeau, Jean-Marc .

AMERICAN JOURNAL OF SURGERY, 2009, 197 (06) :702-709

[9] Postoperative pancreatic fistula: We need to redefine grades B and C [J].

Hackert, Thilo ;

Hinz, Ulf ;

Pausch, Thomas ;

Fesenbeck, Irina ;

Strobel, Oliver ;

Schneider, Lutz ;

Fritz, Stefan ;

Buechler, Markus W. .

SURGERY, 2016, 159 (03) :872-877

[10] A Pancreaticoduodenectomy Risk Model Derived From 8575 Cases From a National Single-Race Population (Japanese) Using a Web-Based Data Entry System The 30-Day and In-hospital Mortality Rates for Pancreaticoduodenectomy [J].

Kimura, Wataru ;

Miyata, Hiroaki ;

Gotoh, Mitsukazu ;

Hirai, Ichiro ;

Kenjo, Akira ;

Kitagawa, Yuko ;

Shimada, Mitsuo ;

Baba, Hideo ;

Tomita, Naohiro ;

Nakagoe, Tohru ;

Sugihara, Kenichi ;

Mori, Masaki .

ANNALS OF SURGERY, 2014, 259 (04) :773-780

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