The Analysis Of Risk Factors Of Pancreatic Fistula After Pancreaticoduodenectomy And The Initial Establishment Of A New Predictive Scoring System

Objective:Postoperative pancreatic fistula is asevere complication afterpancreaticoduodenectomy. The aim of this study was to analyze the risk factors ofpostoperative pancreatic fistula, establish a new predictive scoring system and identify astandardized clinical management.Methods:The data of310casesundergoingpancreaticoduodenectomyin our hospitalbetween January2005and May2013were reviewed retrospectively to analyze thepancreaticfistula．19preoperative, intraoperative, and postoperative variables werecollected to be analyzed with univariate and multivariate Logistic regression. Bring out apreliminary analysis of the risk factors, a new scoring system and standardized treatmentsof postoperative pancreatic fistula after pancreaticoduodenectomy.Results A total of310patients underwent pancreaticoduodenectomy in our hospital. Theoverall morbidity and hospital mortality were43.2%(134/310)and1.3%(4/310).103patients (33.2%) developed a postoperative pancreatic fistula; among them40patients(38.8%) developed additional complications and one of them died (1/103). Preoperativehemoglobin, preoperative bilirubin, pancreatic duct diameter and postoperative albuminwere significantly associated with postoperative pancreatic fistula. With the multivariateanalysis, preoperative bilirubin, pancreatic duct diameter and postoperative albumin werefound to be independent risk factors. Apredictive scoring system for pancreatic fistula (3-8points) was constructed using these3independentrisk factors. The nomogram showed anarea under the curve (AUC) of0.777, which had a sensitivity of88.3%and specificity of58.0%. The median survival time of all patients was25.1months, which were23.6months in the group of pancreatic fistula and26.3months in another. No significant differencewas found between these two groups..Conclusions: Postoperative pancreatic fistula is one of the major complicationsofpancreaticoduodenectomy, but has a good outcome after the standardized diagnosis andtreatment. Preoperative jaundice, small pancreatic duct and postoperative hypoalbumin arethe risk factors for pancreatic fistula development. This scoring system was predictive forpancreatic fistula. Postoperative pancreatic fistula has no influence on the long-termsurvive.