Predictors and prognosis of postoperative high fluid discharge after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma

Abstract

Background: Pancreaticoduodenectomy (PD) is widely performed for peri-pancreatic head tumors. High non-chylous fluid discharge is a frequent complication after PD in addition to pancreatic fistula, delayed gastric emptying (DGE) and chylous ascites, and can extend hospital stay or increase fatal sequelae. Methods: From August 2008 to June 2015, consecutive 102 patients underwent PD for pancreatic ductal adenocarcinoma (PDA). High non-chylous fluid discharge was defined as postoperative daily discharge exceeding 10 mL/kg. Predictive factors for high fluid discharge and prognosis were analyzed. Results: Fifty-one patients developed high fluid discharge (the high-fluid group). Median body mass index (BMI) and the levels of hemoglobin, total protein, and cholinesterase were significantly lower in the high-fluid group than in the low-fluid group, respectively. DGE rate was significantly higher in the high-fluid group than in the low-fluid group: 35.3% vs. 11.8%, P=0.009. Multivariable analysis revealed that BMI < 22.0 kg/m2 (odds ratio, 10.6, P < 0.001), hemoglobin <12.0 g/dl (odds ratio, 4.9, P = 0.014), and intraoperative blood loss ≥800 mL (odds ratio, 3.8, P = 0.038) were independent predictive factors for high fluid discharge. The extent of lymph nodes (LN) dissection, portal vein (PV) resection and reconstruction, superior mesenteric artery (SMA) plexus dissection were not significant predictors. There were no significant differences in overall survivals between the groups. Conclusions: Preoperative poor conditions (low levels of BMI and hemoglobin) and intraoperative high blood loss were associated with higher incidence of high fluid discharge rather than the extent of LN and SMA plexus dissection or PV resection.