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Assessment of preoperative clinicophysiological findings as risk factors for postoperative pancreatic fistula after pancreaticoduodenectomy

Objective Postoperative pancreatic fistula (POPF) is one of the severe complications that develop after pancreaticoduodenectomy (PD). This study aimed to assess the utility of preoperative clinicophysiological findings as risk factors for POPF after PD. Summary of Background Data We enrolled 350 patients who underwent PD between 2007 and 2012 at Tokyo Women’s Medical University. Methods In total, 350 patients who underwent PD between 2007 and 2012 were examined retrospectively. All patients were classified into two groups as follows: group A (no fistula/ biochemical leak group, 289 patients) and group B (grade B/C of POPF group 61 patients). Variables, including operative characteristics, length of stay in hospital, morbidity, mortality, and data regarding preoperative clinicophysiological parameters were collected and analyzed as predictors of POPF for univariate and multivariate analyses. Results There were 213 male and 137 female patients. The mean age was 65.4 years (range: 21-87years). Univariate analysis showed that sex (p=0.047), amylase (p=0.032), prognostic nutritional index (PNI) (p=0.001), C-reactive protein/Albumin ratio (p=0.005) were independent risk factors for POPF. In contrast, multivariate analysis showed that sex (p=0.045) and PNI (p=0.012) were independent risk factors for POPF. Conclusions Our results show that PNI (≤48.64 U/mL) and male sex were risk factors for POPF after PD, and especially, PNI can be suggested as an effective biomarker for POPF.