Pancreatic Fistula after Pancreaticoduodenectomy: Diagnosed according to International Study Group Pancreatic Fistula (ISGPF) Definition

Aims: The aim of the study is to validate a new classification of pancreatic fistula (PF) and to document riskfactors for PR Methods: A retrospective study was performed on 100 patients who underwent pancreaticoduodenectomy (PD) within a 2-year period. PF was diagnosed according to the criteria developed by an International Study Group on Pancreatic Fistula (ISGPF). Sixteen pre- and intraoperative risk factors for PF were analyzed. Results: Of 100 patients 32 developed PF; grade A in 21 patients, grade B in 10, and grade C in 1. Four riskfactors including pathological diagnosis, concomitant surgery, diameter of pancreatic duct, and texture of the remnant pancreas were found to be significantly associated with PF by univariate analysis. Texture of the remnant pancreas and concomitant surgery were demonstrated to be independent risk factors by multivariate logistic regression. If a PF occurred, advanced age was found to be a risk factor for PF grade B by univariate analysis, but age was not an independent risk factor by multivariate logistic regression. Conclusions: The status of the remnant pancreas is identified as a substantial risk factor for PF after PD. When soft remnant pancreas is encountered, more careful handling is required in an attemptto minimize the rate of PF. This study confirms that the ISGPF classification of PF is useful.