Prediction of Clinically Relevant Pancreatic Fistula in the Early Phase after Distal Pancreatectomy

Background Postoperative pancreatic fistula remains a major complication after distal pancreatectomy. We investigated the predictors of clinically relevant PF in the early phase after distal pancreatectomy. Methods Between July 2009 and March 2017, 101 consecutive patients underwent distal pancreatectomy at Hyogo College of Medicine. The postoperative data were collected, and the predictors for cPF after distal pancreatectomy were identified. Results cPF was identified in 34 (34%) patients. In the multivariate analysis, 2 factors (serum C-reactive protein (CRP) >= 10 mg/dL and amylase value in drain (d-AMY) >= 1200 U/L) were found to be independently the predictive factors of cPF on postoperative day 4 (odds ratio, 6.4; 95% confidence interval, 2.4-16.8, p<0.001 and odds ratio, 3.4; 95% confidence interval, 1.3-8.9, p=0.011, respectively). A scoring scale for the prediction of cPF was developed. Serum CRP >= 10 mg/dL (Score: 2) and d-AMY >= 1200 U/L (Score: 1) were included in the scoring scale, and a score of 2 yielded the optimal diagnosis value for cPF (AUC=0.780). Therefore, only 1 factor-CRP >= 10 mg/dL-was found to be independently predictive of cPF on POD 4. Conclusion Serum CRP = 10 mg/dL was found to be a predictive factor for cPF on POD 4 after distal pancreatectomy.