Jikei University Research Articles

CA19-9 Concentration After First-line Chemotherapy Is Prognostic Predictor of Metastatic Colon Cancer.

To evaluate whether the serum levels of CEA or CA19-9 concentration is a useful predictor of survival in patients with metastatic colon cancer (mCC). Between 2012 and 2015, 113 patients with mCC who underwent chemotherapy according to the Japanese Colorectal Cancer Treatment Guidelines at four Jikei University Hospitals were enrolled in this study. The two serum tumor makers, CEA and CA19-9 were measured before first-line chemotherapy and at four months thereafter. Serum CA19-9 concentration at four months after first-line chemotherapy (p=0.003, HR=3.761) and first-line chemotherapy including oxaliplatin (p=0.038, HR=0.312) were independent predictors of survival in patients with mCC. By excluding the transverse colon, only serum CA19-9 concentration at four months after first-line chemotherapy (p=0.005, HR=3.660) was identified as the predictor of survival. Serum CA19-9 concentration after first-line chemotherapy seems to be a useful predictor of survival in patients with mCC.

1069. Predictive Factors for Metastatic Infection in Patients With Bacteremia Caused by Staphylococcus aureus

BackgroundMetastatic infections, such as infective endocarditis and pyogenic spondylitis, are very serious complications of Staphylococcus aureus bacteremia (SAB), because failure to identify metastatic infections may cause poor prognosis. The aim of the present study is to determine the predictive factors for metastatic infections of SAB.MethodsThis retrospective cohort study was conducted among patients with bacteremia due to S. aureus (including both methicillin-sensitive S. aureus and methicillin-resistant S. aureus: MSSA and MRSA) in The Jikei University Kashiwa Hospital. The study population comprised 125 adult patients with SAB between January 2014 and December 2017. Patients, that died or transferred within 3 months after the initial positive blood culture, were excluded, because metastatic infection was defined as deep-seated infection detected within 3 months after the initial positive blood culture. We analyzed several factors, including demographics, comorbidities, community acquisition, primary site of infection, persistent fever and laboratory data such as c-reactive protein (CRP) levels after treatment.ResultsSeventy-four patients met inclusion criteria of this study. The most common primary site of bacteremia was catheter-related [24 (32.4%) of 74]. Metastatic infection occurred in 22 (29.7%) of 74 patients, and spondylitis was most common, following psoas abscess. Of these, 11 infections (50% of 22) were community acquired. We did not find any significant differences in demographics and comorbidities, except central venous catheter-associated bloodstream infection, which was associated with low rate of metastatic infection. By multivariate analysis, the predictive factors associated with the development of metastatic infection were community onset of infection (OR 11.6; 95% CI 2.98–45.1; P < 0.001), persistent fever over 72 hours (OR 6.7; 95% CI 2.12–21.8; P = 0.001), and higher CRP levels (>3 mg/dL) lasting 2 weeks after the administration of appropriate antibiotics (OR 7.47; 95% CI 2.39–23.3; P < 0.001).ConclusionThis study demonstrated that additional diagnostic tests to identify metastatic infection should be performed, especially in the patients with community-acquired SAB, persistent fever or persistently high CRP levels after the administration of appropriate antibiotics.Disclosures All authors: No reported disclosures.

CLINICAL PRESENTATION AND OUTCOMES OF PENILE FRACTURE: RETROSPECTIVE ANALYSIS OF 16 PATIENTS

(Background) Penile fracture as a result of sexual activity is exceedingly rare. Therefore, few studies have investigated it specifically in Japan. (Methods) We evaluated the clinical features and complications of all patients with penile fractures treated at Jikei University Hospital between 2005 and 2017. A total of 16 patients were identified and their etiologies, symptoms, treatment strategy, operative approach, and complications were reviewed. (Results) The median patient age was 41 years (range: 22-67). We were able to identify the etiology in 15 patients: 5 patients (31%) had suffered the fracture during sexual intercourse and 4 (25%) during masturbation. All patients were not suspected of having urethral injury. Eight patients underwent magnetic resonance imaging (MRI) prior to surgical repair. Disruption of tunica albuginea could be identified in all 7 patients with decent descriptions of the findings recorded for review. All patients underwent surgery, and the ruptured tunica albuginea was repaired. None of the patients developed erectile dysfunction (ED) but 1 patient (6%) had postoperative penile curvature. (Conclusions) Penile fracture most frequently occurred during sexual intercourse and masturbation. Our series had no ED, but longer follow-up is needed to draw definitive conclusions.

Short-term outcomes of laparoscopic hepatectomy in extremely elderly patients

Introduction: In developed countries, Laparoscopic hepatectomy has been widely performed in recent years. However, few studies have reported the outcome of laparoscopic hepatectomy in elderly patients. Herein we report short-term outcomes of laparoscopic hepatectomy in extremely elderly patients. Methods: From July 2006 to August 2017, 71 patients underwent laparoscopic hepatectomy at Jikei University Hospital. Of these, seven patients (10 %) were older than 80 years at surgery. We compared the short-term outcomes of laparoscopic hepatectomy in extremely elderly patients (≥ 80 years of age; (group A, n=7) and non-extremely elderly patients (< 80 years of age; (group B, n=64), as well as extremely elderly patients undergoing open minor hepatectomy during the same period (group C, n=13). Result: The mean age of Group A, B, and C were 82.6, 59.7 and 83.9 years, respectively. The preoperative ASA score (1/2/3) was 0/6/1 in group A, 11/46/7 in group B, and 0/12/1 in group C. The indications (primary cancer/metastatic/others) in group A, B, and C was 3/4/0, 32/18/14, and 8/5/0, respectively. The conversion rates from laparoscopy to laparotomy, and the postoperative hospital stay were comparable between group A and B (14% versus 16%, p=1.000; 9.7 days versus 8.8 days, p=0.802). The incidences of postoperative complications among three groups were comparable {14%, 8% versus 15%, p (A versus B) =0.559, p (A versus C) =0.948}, and there was no in-hospital mortality in these three groups. Conclusion: Laparoscopic hepatectomy seems to be safe and acceptable in extremely elderly patients.

Prognostic significance of Wilms' tumor 1 expression in patients with pancreatic ductal adenocarcinoma.

The only current curative treatment for patients with pancreatic ductal adenocarcinoma (PDA) is surgical resection, and certain patients still succumb to disease shortly after complete surgical resection. Wilms' tumor 1 (WT1) serves an oncogenic role in various types of tumors; therefore, in the present study, WT1 protein expression in patients with PDA was analyzed and the association with overall survival (OS) and disease-free survival (DFS) time in patients with PDA was assessed following surgical resection. A total of 50 consecutive patients with PDA who received surgical resection between January 2005 and December 2015 at the Jikei University Kashiwa Hospital (Kashiwa, Chiba, Japan) were enrolled. WT1 protein expression in PDA tissue was measured using immunohistochemical staining. Furthermore, laboratory parameters were measured within 2 weeks of surgery, and systemic inflammatory response markers were evaluated. WT1 protein expression was detected in the nucleus and cytoplasm of all PDA cells and in tumor vessels. WT1 exhibited weak staining in the nuclei of all PDA cells; however, the cytoplasmic expression of WT1 levels was classified into four groups: Negative (n=0), weak (n=19), moderate (n=23) and strong (n=8). In patients with PDA, it was demonstrated that the OS and DFS times of patients with weak cytoplasmic WT1 expression were significantly prolonged compared with those of patients with moderate-to-strong cytoplasmic WT1 expression, as determined by log-rank test (P=0.0005 and P=0.0001, respectively). Furthermore, an association between the density of WT1-expressing tumor vessels and worse OS/DFS times was detected. Multivariate analysis also indicated a significant association between the overexpression of WT1 in PDA tissue and worse OS/DFS times. To the best of our knowledge, the present study is the first to demonstrate that moderate-to-strong overexpression of WT1 in the cytoplasm of PDA cells is significantly associated with worse OS/DFS times. Therefore, overexpression of WT1 in the cytoplasm of PDA cells may impact the recurrence and prognosis of patients with PDA following surgical resection. The results further support the development of WT1-targeted therapies to prolong survival in all patients with PDA.

Editorial introductions

Editorial introductions

Initial 10 cases of living-donor liver transplantation for primary biliary cholangitis at Jikei University Hospital

Initial 10 cases of living-donor liver transplantation for primary biliary cholangitis at Jikei University Hospital

The beneficial effects of long-term enzyme replacement therapy on cardiac involvement in Japanese Fabry patients

Fabry disease is a hereditary disorder that occurs due to the reduction or absence of alpha-galactosidase A activity, which leads to cardiac involvement including left ventricular hypertrophy (LVH). Enzyme replacement therapy (ERT) provides better patient outcomes by preventing serious complications. However, there have been very few studies on the long-term effects of ERT on the cardiac manifestations in Japanese Fabry patients. We retrospectively analyzed the data from the medical records of 42 Fabry patients (male, n = 17; female, n = 25) who were followed at Jikei University Hospital, and in whom the long-term effects of ERT could be evaluated (median follow-up period: male, 11 years; female, 8 years). The slope of the left ventricular mass (LVM) increase was 3.02 ± 3.41 g/m2/year in males and 1.69 ± 2.73 g/m2/year in females. In a subgroup analysis, the slopes of males with and without LVH did not differ to a statistically significant extent; however, the slope in female patients without LVH was significantly smaller than that of female patients with LVH. We then compared our data to the natural historical data that have previously been reported. In comparison to the previously reported data, we found a significant reduction in the LVM changes (g/height2.7/year) of patients who received long-term ERT (male, 4.07 ± 1.03 to 1.25 ± 1.39; female, 2.31 ± 0.81 to 0.78 ± 1.23). Long-term ERT effectively prevents LVH in Fabry patients. This effect was also observed in the patients with LVH prior to the initiation of ERT.

Earlier use of androgen receptor-axis-targeted drugs may improve overall survival in patients with non-metastatic castration-resistant prostate cancer.

To evaluate the role of androgen receptor-axis-targeted drugs (ARAT) in non-metastatic castration-resistant prostate cancer (nmCRPC) versus mCRPC. Chemotherapy-naive patients (n = 114) with CRPC who had no metastasis at the time of diagnosis were included in this retrospective study. All patients were treated with ARAT at Jikei University and its affiliated hospitals from July 2014 to March 2017. The patients were stratified into nmCRPC (n = 81) and mCRPC (n = 33) groups according to their metastatic status at ARAT induction. The primary outcome measure was difference in overall survival (OS) between groups from the time of CRPC diagnosis. The patients were compared for progression-free survival (PFS) and prostate-specific antigen (PSA) response. The predictors of OS were explored by a multivariate Cox model. The baseline demographics did not differ significantly between the groups. The median observation period from the diagnosis of CRPC was 24.5 months (range: 3-135) and 20 months (range: 1-66) in nmCRPC and mCRPC groups, respectively. The nmCRPC group demonstrated better OS from the time of diagnosis of CRPC in Kaplan-Meier analysis than mCRPC group (86 months vs 40 months; P = 0.004), with similar results obtained for PFS (P = 0.048) and PSA response (P = 0.0014). Multivariate analysis demonstrated non-metastatic status, low PSA, and long PSA doubling time (PSADT) at ARAT induction as the significant predictors of longer OS (P = 0.044, 0.0001, and 0.026, respectively). Early use of ARAT may improve OS, PFS, and PSA response in CRPC. Larger, prospective studies will be required to confirm our findings.

Measurement of daily sodium excretion in patients with chronic kidney disease; special reference to the difference between the amount measured from 24 h collected urine sample and the estimated amount from a spot urine

It is important to grasp a patient’s daily sodium intake in the management of chronic kidney disease, as sodium intake is widely recommended at 6 g/day or less. There are multiple equations widely known for estimating the daily sodium excretion from a spot urine sample, but these are aimed at healthy people. There are few reports that validate equations in patients with chronic kidney disease. The purpose of this study is to evaluate whether the amount of measured daily sodium excretion from a sample collected for 24-h urine (24HU) is equal to that of using an equation from a spot urine sample (SU) in patients with chronic kidney disease. One hundred sixty-two patients with chronic kidney disease from Kanagawa Prefecture Shiomidai Hospital, Japan and the Jikei University Kashiwa Hospital, Japan participated in the study. Daily sodium excretion was measured from 24HU and compared with it from SU by using the formula according to Tanaka et al. Sodium excretion by 24HU was 2744 mg/day and estimating daily sodium excretion from SU was 3315 mg/day. The coefficient of determination was 0.17 (p < .001) in multivariate regression analysis. The coefficient of determination was extremely low. Thus, there is a considerable difference between the amount of sodium excretion calculated from a 24HU and that from a SU in patients with chronic kidney disease.

Foveal threshold and photoreceptor integrity for prediction of visual acuity after intravitreal aflibercept on age-related macular degeneration.

PurposeTo determine whether baseline foveal threshold and photoreceptor integrity can predict best-corrected visual acuity (BCVA) at 12 months after intravitreal aflibercept (IVA) therapy in eyes with neovascular age-related macular degeneration (AMD).Patients and methodsWe evaluated 25 eyes of 25 patients with treatment-naïve neovascular AMD who received IVA once a month for 3 months, followed by once every 2 months for 8 months. BCVA, integrity of the external limiting membrane (ELM) or the ellipsoid zone (EZ) of the photoreceptors, and retinal sensitivity were determined before (baseline) and at 6 and 12 months after initial IVA. The average threshold foveal sensitivity and mean deviation within the central 10° were determined by Humphrey central 10-2 perimetry. Correlations between BCVA at 12 months and integrity of the ELM or EZ, foveal threshold, and mean deviation at each visit were determined.ResultsAt 12 months, BCVA improved significantly from 0.20±0.23 to 0.10±0.22 logMAR (logarithm of the minimum angle of resolution) units, and foveal threshold and mean deviation improved significantly from 29.0±5.1 and −3.38±3.10 dB to 32.6±3.2 and −1.64±2.10 dB, respectively (P=0.0009 and P=0.0021). At baseline, both foveal threshold and integrity of the ELM were significantly correlated with BCVA at 12 months (P=0.0428 and P=0.0275).ConclusionThese results indicate that both integrity of the ELM and foveal threshold at baseline can predict BCVA after treatment for neovascular AMD. There is a possibility that these parameters can predict the efficacy of IVA in each case.

Urine connectin/titin is increased in patients after heart surgery with cardiopulmonary bypass

Background and ObjectiveCardiac surgery with cardiopulmonary bypass (CPB) may accidentally cause perioperative cardiac injury, which would increase in the risk of substantial post‐operative morbidity and mortality. Therefore, the accurate evaluation of cardiac injury is important for patient care after surgery. Although several biomarkers from patients' serum have been already clinically available to detect cardiac injury, a sensitive urine biomarker for cardiac injury has not yet been established. Recently, N‐terminal fragment of connectin/titin (N‐connectin), a giant sarcomeric protein, has been reported to detect muscle damages in patients with skeletal muscle dystrophy and healthy volunteer with endurance exercise. In the present study, we tested whether urine N‐connectin can be a novel biomarker to detect cardiac damage after cardiac surgery with CPB.Methods and ResultsWe measured urinary levels of N‐connectin/creatinine (N‐connectin/Cr; pmol/mg/dl) in 13 patients (9 male, 4 female; 63±16 years old) who had undergone cardiac surgery with CPB have given informed consent to participate. The patients included 5 on‐pump coronary artery bypass graft surgery and 8 open‐heart surgery for various heart diseases. Urine N‐connectin/Cr before operation was 3.8 ± 2.8 pmol/mg/dL and it was significantly increased in all patients after surgery (42.8. ±16.4 pmol/mg/dL at the operation day). Serum creatine phosphokinase‐MB isozyme (CK‐MB) before operation was 7.6 ± 2.7 U/L and it was also significantly increased after surgery (48.0. ± 37.4 U/L at the operation day). Although serum CK‐MB was rapidly decreased to the pre‐operative level 3 days after operation, urine N‐connectin/Cr was still significantly high 3 days after operation (29.5 ±10.4 pmol/mg/dL). There was no difference in Urine N‐connectin/Cr between patients who underwent on‐pump coronary artery bypass graft surgery and open‐heart surgery. Urine N‐connectin/Cr at the operation day had no correlation with other parameters including serum CK‐MB, cardiopulmonary bypass time, duration of Intensive care stay, and post‐operative left ventricular ejection fraction.ConclusionUrinary N‐connectin/Cr was significantly increased after CPB and maintained high values at least 3 days after surgery. Urinary N‐connectin/Cr may be useful to detect the risk of substantial post‐operative cardiac damage.Support or Funding InformationThis work was supported by grants from The the Jikei University research found.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Dr. Noda, et al reply.

We appreciate the comments provided by Dr. Bhansing and colleagues1 in response to our article2. Recently, Bhansing, et al showed a significant 2-fold increase in the fascia thickness of the deltoid muscles on ultrasonography (US) in patients with dermatomyositis (DM) and polymyositis (PM) relative to healthy controls3. Additionally, they showed that the deltoid fascial thickness on US in patients with DM and PM was not associated with various clinical variables, including the disease duration, serum creatine kinase, the Health Assessment Questionnaire–Disability Index score, sex, antinuclear antibody, anti-Jo1, the subtype of idiopathic inflammatory myopathy, the clinical disease … Address correspondence to Dr. K. Noda, Division of Rheumatology, Department of Internal Medicine, the Jikei University School of Medicine, 3-25-8 Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan. E-mail: knoda3353{at}jikei.ac.jp

Risk Factors for Incisional Hernia in Children.

Incisional hernia (IH) is a major complication of abdominal surgery. Although previous studies reported that the incidence of IH after abdominal surgery in adults was 5-50% and that various independent risk factors were involved, IH in children is still not well known. The objective of our study was to investigate the incidence and risk factors for IH in children. We retrospectively reviewed all children who underwent abdominal surgery at the Jikei University Hospitals (Jikei University Hospital, Kashiwa Hospital, Katsushika Medical Center and Daisan Hospital) between January 2001 and December 2016. Abdominal surgery in children was defined as open laparotomy and laparoscopic abdominal surgery in patients≤15years old. Conventional open repair for inguinal hernias, umbilical hernia repair, congenital abdominal defect repair and orchiopexy were excluded. Overall, 2049 children were performed abdominal surgery. Among them, 14 children (10 males and 4 females) developed IH, and the incidence of IH was 0.68% (14/2049). There is no significant difference between laparotomy and laparoscopic surgery. The statistically significant variables and identified risk factors were operation in neonates, laparoscopic fundoplication and open supraumbilical pyloromyotomy. In all patients who had IH repair, there was no recurrence during the follow-up period 50.4months (range 1months-10years) except two recurrence cases. The incidence of IH in children is significantly lower than that in adults, and the above three risk factors were revealed. Before abdominal surgery, we recommend that pediatric surgeons should mention the risk of developing IH when the patient has the above risk factors.

Aortic rupture involving matrix metalloproteinases 8 and 9 during Staphylococcus aureus pneumonia

An 87-year-old man was admitted to Jikei University Hospital presenting with fever and fatigue. Physical examinations revealed inspiratory coarse crackles on the left lung field. A chest CT detected a...

High resolution imaging analysis of female carriers and patients of Choroideremia with CHM gene mutation

PurposeTo report the high resolution imaging features of Japanese patient and female carriers of choroideremia using adaptive optics(AO) and other imaging modalities.MethodsThree carriers and one patient underwent comprehensive examinations including AO fundus camera (rtx1™ Imagine eyes, France), spectral domain optical coherence topography (SD‐OCT)and fundus autofluoresence (FAF). Cone density was measured by peak density method and compared with the data of 34 normal controls. The mutation analysis of the CHM gene was performed by Sanger sequencing. The protocol conformed to the tenets of the Declaration of Helsinki and was approved by the IRB of The Jikei University and Nippon Medical School.ResultsThree female carriers 1, 2, 3 (sister 9 y.o, mother 37 y.o and grandmother 65 y.o) and one patient (6 y.o, male). They had same CHM mutation, c.646delA, p.T216LfsX16. All carriers did not complain any symptoms, the BCVA of all were over 20/20. Fundus examination of carrier 2 showed mild generation in only periphery, the other carriers showed diffuse degeneration. AF showed mottled hypo‐autofluoresence in degeneration area. SD‐OCT of the carriers showed nearly normal,although peripheral SD‐OCT and patient showed diffuse disruptions of interdigitation and ellipsoid zones.Cone density was measured at 2 to 8 degree temporal from the fovea in every 1 degree, using 50 x 50 micron images. Cone counting was performed by AO detect (Imagine eyes) with manual correction. Patient showed lower cone density more than 2 SD of normal control. The carriers showed lower cone density only at 7 and 8 degrees.ConclusionsAO cone counting showed reduction of photoreceptors in carriers mainly at peripheral region. To elucidate the mechanism of peripheral degeneration and foveal sparing of female carriers may help preventing the disease progression of choroideremia patients.

購入外国雑誌選定における Journal Citatlon Reports(JCR)の利用 : 東京慈恵会医科大学医学情報センターの例 ( ジャーナルのコストパフォーマンス)

購入外国雑誌選定における Journal Citatlon Reports(JCR)の利用 : 東京慈恵会医科大学医学情報センターの例 ( ジャーナルのコストパフォーマンス)

Laparoscopic surgical challenge for T4a colon cancer.

For patients with T4a colon cancer, the risk of peritoneal dissemination after surgery remains unclear. Seven hundred and eleven patients with T3 or T4a colon cancer, 80 years of age or younger, underwent curative resection (open surgery in 512 and laparoscopic surgery in 199) at the four Jikei University hospitals between 2006 and 2012. Their risk factors for peritoneal dissemination after surgery were evaluated retrospectively. Number of lymph node metastases, postoperative liver metastases and postoperative peritoneal dissemination events in the T4a group were significantly greater than the number in the T3 group. Peritoneal dissemination after surgery developed in four patients (0.7%) in the T3 group and in six patients (5%) in the T4a group. Risk factors for peritoneal dissemination consisted of macroscopic type (P = 0.016), serosal invasion (P = 0.017) and number of lymph node metastases (P = 0.009) according to the Cox proportional hazards regression model. However, tumor diameter and surgical approach (laparoscopic vs open) were not significant factors for peritoneal dissemination. There were no significant differences between the postoperative relapse‐free survival rates for each surgical approach within the T3 or T4a group. Because of comparable postoperative peritoneal dissemination in T3 and T4a colon cancer by the surgical approach (laparoscopic or open), laparoscopic surgery for patients with T4a colon cancer seems justified.

EXPRESSION OF PLAKIN FAMILY IN UROTHELIAL CARCINOMA OF THE UPPER URINARY TRACT

(Objective) To determine whether the plakin family proteins periplakin, desmoplakin, plectin, and envoplakin could be markers of urothelial carcinoma of the upper urinary tract. (Materials and methods) Fifty-seven surgical specimens were obtained from patients with urothelial carcinoma of the upper urinary tract, who were admitted to the Jikei University Hospital between April 2000 and December 2005. The expression of plakin family proteins in cancerous and normal tissues was investigated using immunohistochemistry, and its association with clinicopathological parameters was analyzed. (Results) The expression of periplakin, envoplakin, and desmoplakin was significantly lower in cancerous tissue than in normal urothelium (P < 0.0001, P < 0.0001, and P < 0.0001, respectively). Strong desmoplakin expression in cancerous tissue was significantly associated with poor cancer-specific survival and overall survival (P = 0.023 and P = 0.034, respectively, compared with cancerous tissue with slight or less desmoplakin expression). Furthermore, strong plectin expression was significantly associated with poor metastasis-free survival (P = 0.034, compared with cancerous tissue with slight or less plectin expression). (Conclusion) Plakin family, particularly desmoplakin was suggested to be a prognostic marker of urothelial carcinoma of the upper urinary tract.

The Decline of Amylase Level of Pancreatic Juice After Pancreaticoduodenectomy Predicts Postoperative Pancreatic Fistula.

Postoperative pancreatic fistula (POPF) is a life-threatening complication after pancreaticoduodenectomy (PD). The aim of this study is to evaluate the significance of pancreatic amylase level of pancreatic juice for PF after PD. The subjects were 46 patients who underwent PD between January 2012 and August 2015 at Jikei University Hospital. We retrospectively investigated the relation between patient characteristics including pancreatic amylase level of pancreatic juice through the pancreatic drainage tube and the incidence of POPF (grade B or grade C according to the International Study Group on the Pancreatic Fistula) using univariate and multivariate analyses. The decline of pancreatic amylase level of pancreatic juice was evaluated by 1 - postoperative day 3/postoperative day 1 ratio. In univariate analysis, nonductal adenocarcinoma (P = 0.0252), soft pancreatic remnant (P = 0.0155), and decline of pancreatic amylase level of pancreatic juice ≥ 80% (P = 0.0010) were significant predictors of POPF. In multivariate analysis, decline of pancreatic amylase level of pancreatic juice of 80% or greater (P = 0.0192) was the only significant independent parameter. Decline of pancreatic amylase level of pancreatic juice can predict POPF after PD.