Preoperative predictive factors of pancreatic fistula after pancreaticoduodenectomy: usefulness of the CONUT score

Masashi Utsumi; Hideki Aoki; Seiichi Nagahisa; Seitaro Nishimura; Yuta Une; Yuji Kimura; Megumi Watanabe; Fumitaka Taniguchi; Takashi Arata; Koh Katsuda; Kohji Tanakaya

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저자정보: Masashi Utsumi (Iwakuni Clinical Center) Hideki Aoki (Iwakuni Clinical Center) Seiichi Nagahisa (Iwakuni Clinical Center) Seitaro Nishimura (Iwakuni Clinical Center) Yuta Une (Iwakuni Clinical Center) Yuji Kimura (Iwakuni Clinical Center) Megumi Watanabe (Iwakuni Clinical Center) Fumitaka Taniguchi (Iwakuni Clinical Center) Takashi Arata (Iwakuni Clinical Center) Koh Katsuda (Iwakuni Clinical Center) Kohji Tanakaya (Iwakuni Clinical Center)

저널정보: 대한외과학회 Annals of Surgical Treatment and Research Annals of Surgical Treatment and Research Vol.99 No.1

발행연도: 2020.7

수록면: 18 - 25 (8page)

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Purpose: Postoperative pancreatic fistula (POPF) is the most important factor affecting morbidity and mortality after pancreaticoduodenectomy (PD). Patients with a high controlling nutritional status (CONUT) score, which is used to assess nutritional status, are expected to have high morbidity rates. This study aimed to determine the usefulness of the CONUT score.
Methods: Data from 97 consecutive cases of PD performed in the Department of Surgery of Iwakuni Clinical Center, from April 2008 to May 2018, were included. Preoperative patient data, including sex, age, and hypertension, and postoperative complication data were collected to analyze pancreatic fistula occurrence.
Results: Of the 97 patients, 2 9 patients (29.8%) were diagnosed with POPF ≥ B, with 26 cases (26.8%) classified as grade B and 3 (3.1%) as grade C. The mortality rate was 2.1% (2 of 97). In the univariate analysis, a significant association was observed between POPF and the following factors: body mass index (BMI) ≥ 22 kg/m², high CONUT score, nonpancreatic carcinoma, and CT attenuation values. In multivariate analysis, BMI ≥ 22 kg/m² (odds ratio [OR], 6.16; P < 0.001), high CONUT score (OR, 3.77; P = 0.009), nonpancreatic carcinoma (OR, 5.72; P = 0.009), and CT attenuation values (late/early ratio) in the pancreas (OR, 9.07; P = 0.006) were independent risk factors for POPF.
Conclusion: Patients with a high CONUT score are at high risk of POPF. Further study correlating preoperative nutritional intervention with risk of POPF is necessary.

#CONUT score #Pancreatic fistula #Pancreaticoduodenectomy

참고문헌 (30)

참고문헌 신청

Brown EG / 2014 / Outcomes of pancreaticoduodenectomy:where should we focus our efforts on improving outcomes? / JAMA Surg 149:694~699

Kimura W / 2014 / 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 / Ann Surg 259:773~780

Wang Y / 2012 / Preoperative biliary drainage for obstructive jaundice / Cochrane Database Syst Rev 9:CD005444

Winter JM / 2007 / Biochemical markers predict morbidi t y and mor t a l i t y a f t e r pancreaticoduodenectomy / J Am Coll Surg 204:1029~1036

Sugimoto M / 2013 / Schematic pancreatic configuration : a risk assessment for postoperative pancreatic fistula after pancreaticoduodenectomy / J Gastrointest Surg 17:1744~1751

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