Analysis of risk factors of clinically relevant pancreatic fistula after laparoscopic pancreaticoduodenectomy

Abstract

Objective This study was to investigate the preoperative and intraoperative risk factors of clinically relevant pancreatic fistula(CRPF)after laparoscopic pancreaticoduodenectomy(LPD). Methods After applying the exclusion criteria, a total of 157 consecutive patients who performed LPD were enrolled in the study. The clinical data were collected and analyzed from Oct. 2010 to Jan. 2017. In this study, ISGPF grade B, C is defined as CRPF, no PF or ISGPF grade A is defined as non-clinically relevant pancreatic fistula(NCRPF). All patients were divided into two groups according to whether the CRPF developed. The preoperative and intraoperative factors which may influence the development of CRPF were analyzed by univariate analysis. Those factors (P< 0.05) which have influence on the development of CRPF were analyzed by multivariate analysis again. Results Sixty-four cases (40.76%) developed PF. Thirty-two (20.38%) of 157 patients developed CRPF. The univariate analysis revealed that the history of drinking, duodenal lesions, resection of pylorus, long operation time, perioperative transfusion, soft pancreas, the maximum temperature of preoperative day may be the risk factors of CRPF. Multivariable analysis showed that soft pancreas and long operation time were independent risk factors of CRPF after LPD. Further analysis showed that the incidence of postoperative bleeding or chylous leakage was significantly decreased, the postoperative hospitalization time was significantly shortened in the group of lower risk of CRPF while the rate of reoperation or puncture was not increased. Conclusions Soft pancreas and long operation time are independent risk factors of CRPF after LPD. For those patients, more attention should be paid and increased positive measures should be taken to prevent the occurrence of CRPF after LPD. Key words: Laparoscopy pancreaticoduodenectomy; Clinically relevant pancreatic fistula; Risk factor; Univariate analysis; Multivariate analysis