To analyze the risk factors for pancreatic fistula after pancreaticoduodenectomy.
METHODS
We conducted a retrospective analysis of 310 successive cases of pancreaticoduodenectomy performed at department of hepatopancreaticobiliary surgery, National liver institute, Menoufia University from 1st Jan 2015 to 31st Dec 2023 . Pancreatic fistula was diagnosed in strict accordance with the definition of pancreatic fistula from the International Study Group on Pancreatic Fistula. The risk factors for pancreatic fistula were analyzed by univariate analysis and multivariate logistic regression analysis.
RESULTS
A total of 90 (29.0%) cases of pancreatic fistula occurred after pancreaticoduodenectomy, including 18 (16.2%) cases of grade A pancreatic fistula, 59(53.1%) cases of grade B, and 13 (11.7%) cases of grade C. Univariate analysis showed no significant correlation between postoperative pancreatic fistula (POPF) and the following factors: age, hypertension, alcohol consumption, smoking, history of upper abdominal surgery, preoperative jaundice management, preoperative bilirubin, preoperative albumin, pancreatic duct drainage, intraoperative blood loss, operative time, intraoperative blood transfusion, Braun anastomosis, and pancreaticoduodenectomy (with or without pylorus preservation). Conversely, a significant correlation was observed between POPF and the following factors: gender (male vs female: 55.6% vs 44.4%, P = 0.671), diabetes (non-diabetic vs diabetic: 38.9% vs 61.1%, P = 0.010), body mass index (BMI) (≤ 25 vs > 25: 44.4% vs 55.6%, P = 0.301), , pancreaticojejunal anastomosis technique (pancreatic duct-jejunum double-layer mucosa-to-mucosa pancreaticojejunal anastomosis vs pancreatic-jejunum single-layer mucosa-to-mucosa anastomosis: 55.6% vs 40.0%, P = 0.019), diameter of the pancreatic duct (≤ 3 mm vs > 3 mm: 53.3% vs 46.7%, P = 0.014), and pancreatic texture (soft vs hard: 54.4% vs 45.6%, P = 0.036). Multivariate logistic regression analysis showed that gender (male), BMI > 25, Diabetes, pancreatic duct-jejunum double-layer mucosa-to-mucosa pancreaticojejunal anastomosis, pancreatic duct diameter ≤ 3 mm, and soft pancreas were risk factors for pancreatic fistula after pancreaticoduodenectomy.
CONCLUSION
Gender (male), BMI > 25,Diabetes, pancreatic duct-jejunum double-layer mucosa-to-mucosa pancreaticojejunal anastomosis, pancreatic duct diameter ≤ 3 mm, and soft pancreas were risk factors for pancreatic fistula after pancreaticoduodenectomy.
Keywords: Pancreaticoduodenectomy, Pancreatic fistula, Pancreaticojejunal anastomosis, Pancreatic duct, Complications
Core tip: Pancreaticoduodenectomy remains the standard surgical approach for tumors involving the lower bile duct, the pancreatic head, the duodenal papilla, and the ampulla. This operation is considered risky because of high rates of postoperative mortality and complications. In this study, we collected a large sample of 310 cases and analyzed several potential risk factors for pancreatic fistula. A statistical analysis of the case data showed that gender (male),BMI >25, Diabetes, pancreatic duct-jejunum double-layer mucosa-to-mucosa pancreaticojejunal anastomosis, pancreatic duct diameter ≤ 3 mm, and soft pancreas were risk factors for pancreatic fistula after pancreaticoduodenectomy.