Association Between the Incidence of Pancreatic Fistula After Pancreaticoduodenectomy and the Degree of Pancreatic Fibrosis

Yong Deng,Yong Deng,Baixiong Zhao,Baixiong Zhao,Meiwen Yang,Chuanhong Li,Chuanhong Li,Leida Zhang,Leida Zhang

doi:10.1007/s11605-017-3660-2

Yong Deng, Yong Deng + Show 7 more

Open Access

https://doi.org/10.1007/s11605-017-3660-2

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Abstract

ObjectiveThe objective of this study is to investigate the association between the incidence of pancreatic fistula after pancreaticoduodenectomy (PD) and the degree of pancreatic fibrosis. MethodBetween January 2013 and December 2016, the analysis of the clinical data of 529 cases of pancreaticoduodenectomy patients of our hospital was performed in a retrospective fashion. The univariate analysis and multivariate analysis were done using the Pearson chi-squared test and binary logistic regression analysis model; correlations were analyzed by Spearman rank correlation analysis. The value of the degree of pancreatic fibrosis to predict the incidence of pancreatic fistula after pancreaticoduodenectomy was evaluated by the area under the receiver operating characteristic (ROC) curve. ResultsThe total incidence of pancreatic fistula after pancreaticoduodenectomy was 28.5% (151/529). Univariate analysis and multivariate analysis showed that BMI ≥ 25 kg/m2, pancreatic duct size ≤ 3 mm, pancreatic CT value< 30, the soft texture of the pancreas (judged during the operation), and the percent of fibrosis of pancreatic lobule ≤ 25% are prognostic factors of pancreatic fistula after pancreaticoduodenectomy (P < 0.05); the pancreatic CT value and the percent of fibrosis of pancreatic lobule in pancreatic fistula group were both lower than those in non-pancreatic fistula group (P < 0.05). Results indicated that there is a negative correlation between the severity of pancreatic fistula and the pancreatic CT value or the percent of fibrosis of pancreatic lobule (r = − 0.297, − 0.342, respectively). The areas under the ROC curve of the percent of fibrosis of pancreatic lobule and the pancreatic CT value were 0.756 and 0.728, respectively. ConclusionThe degree of pancreatic fibrosis is a prognostic factor which can influence the pancreatic texture and the incidence of pancreatic fistula after pancreaticoduodenectomy. The pancreatic CT value can be used as a quantitative index of the degree of pancreatic fibrosis to predict the incidence of pancreatic fistula after pancreaticoduodenectomy.

Highlights

Pancreaticoduodenectomy (PD) is one of the most complicated abdominal surgery.[1]
Results of Pearson chi-squared test indicated that the incidence of pancreatic fistula after PD has a correlation with BMI, preoperative γ-GGT, pancreatic duct size, CT value, surgical time, pancreatic texture, and the percent of fibrosis of pancreatic lobule (P < 0.05); there is no correlation between the incidence of pancreatic fistula after PD and gender, age, diabetes history, hypertension history, history of abdominal surgery, hemoglobin, albumin, total bilirubin, ALT, AST, alkaline phosphatase, surgical method, intraoperative blood loss, or situation of vessels invaded by carcinoma (P > 0.05) (Table 1)
Results of multivariate logistic regression analysis suggested that BMI ≥ 25 kg/m2, pancreatic duct size ≤ 3 mm, CT value < 40, hard texture of pancreas, and percent of fibrosis of pancreatic lobule ≤ 25% are prognostic factors of pancreatic fistula after PD (Table 2)

Summary

Introduction

Pancreaticoduodenectomy (PD) is one of the most complicated abdominal surgery.[1]. In the past decades, the safety of PD procedure has been greatly improved; the incidence of postoperative complications has remained constant during these years. Pancreatic fistula after PD remains one of the intractable complications of PD. It has been estimated that around 50% of postoperative complications after PD are. J Gastrointest Surg (2018) 22:438–443 pancreas CT value can predict the incidence of pancreatic fistula after PD.[10,11] we assume that the degree of pancreatic fibrosis is a key factor which can influence the incidence of pancreatic fistula after PD, and preoperative pancreas CT value can indirectly reflect the degree of pancreatic fibrosis. We analyzed retrospectively 529 patients treated by the Southwest Hospital between 2013 and 2016 to identify some factors which can influence the incidence of pancreatic fistula after PD and to investigate the correlation between the incidence of pancreatic fistula after PD and the degree of pancreatic fibrosis

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Results

Conclusion