Abstract
BackgroundA serious complication after pancreatoduodenectomy (PD) is postoperative pancreatic fistula (POPF). The aim of this study was to analyse the incidence and predictive factors for POPF by using a large nationwide cohort.MethodsData from the Swedish National Registry for Pancreatic and Periampullary Cancer for all patients undergoing a PD from 2010 until 30th June 2018 were collected. The material was analysed in two groups, no POPF and clinically relevant (grade B and C) POPF.ResultsA total of 2503 patients underwent PD, of which 245 (10%) developed POPF. Patients with POPF had significantly more overall complications (Clavien Dindo ≥3a, 75% vs. 21%, p < 0.001) and longer hospital stay (median 23 [16–35] vs. 11 [8–15], p < 0.001) than patients without POPF. The risk of POPF was higher with increased BMI (OR 1.08, p < 0.001). Preoperative presence of diabetes (OR 0.52, p = 0.012) and preoperative biliary drainage (OR 0.34, p < 0.001) reduced the risk of POPF. Reconstruction with pancreaticojejunostomy caused a more than two folded increase in POPF compared with pancreaticogastrostomy (OR 2.41, p < 0.001). Weight gain ≥2 kg on postoperative day 1 was also a risk factor (OR 1.76, p < 0.001).ConclusionA high BMI, a pancreaticojejunostomy and postoperative weight gain were risk factors for developing POPF. Diabetes or preoperative biliary drainage was protective.
Highlights
Postoperative pancreatic fistula (POPF) is one of the most harmful complications after pancreatoduodenectomy (PD), and it is considered to be the main underlying factor for downstream morbidity
The material was analysed in two groups, no postoperative pancreatic fistula (POPF) and clinically relevant POPF
Reconstruction with pancreaticojejunostomy caused a more than two folded increase in POPF compared with pancreaticogastrostomy
Summary
Postoperative pancreatic fistula (POPF) is one of the most harmful complications after pancreatoduodenectomy (PD), and it is considered to be the main underlying factor for downstream morbidity. Obesity, increased operative time, intraoperative blood loss and transfusions and a soft parenchyma are some documented risk factors [2,3,4]. Based on these risk factors, predictive risk scores have emerged [5, 6]. A serious complication after pancreatoduodenectomy (PD) is postoperative pancreatic fistula (POPF). The aim of this study was to analyse the incidence and predictive factors for POPF by using a large nationwide cohort
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