Abstract
Postoperative pancreatic fistula (POPF) is a common complication following pancreaticoduodenectomy (PD). However, risk factors for this complication remain controversial. We conducted a retrospective analysis of 107 patients who underwent PD. POPF was diagnosed in strict accordance with the definition of the 2016 update of pancreatic fistula from the International Study Group on Pancreatic Fistula (ISGPF). Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for POPF. A total of 19 (17.8%) subjects of pancreatic fistula occurred after PD, including 15 (14.1%) with grade B POPF and 4 (3.7%) with grade C POPF. There were 33 (30.8%) patients with biochemical leak. Risk factors for POPF (grade B and C) were larger area of visceral fat (odds ratio [OR], 1.40; p = 0.040) and pathology other than pancreatic adenocarcinoma or pancreatitis (OR, 12.45; p = 0.017) in the multivariate regression analysis. This result could assist the surgeon to identify patients at a high risk of developing POPF.
Highlights
Pancreaticoduodenectomy (PD) is a standard procedure for patients with benign or malignant tumors involving the head of the pancreas and periampullary regions [1,2,3]
A total of 19 (17.8%) patients developed a pancreatic fistula after PD, including 15 (14.1%) with grade B postoperative pancreatic fistula (POPF), and 4 (3.7%) with grade C POPF
The area of visceral fat, visceral fat to Skeletal muscle index (SMI) (VF/SMI) ratio, pancreas hardness and pathology were significantly different between the two groups (Table 2)
Summary
Pancreaticoduodenectomy (PD) is a standard procedure for patients with benign or malignant tumors involving the head of the pancreas and periampullary regions [1,2,3]. Attributable to advancements in surgical techniques and perioperative management, the mortality rate after PD has improved significantly, reportedly reaching 1–2% at high volume centers [4,5,6]. The postoperative morbidity rate remains high, ranging from 27.1% to 43% [6,7,8]. Postoperative pancreatic fistula (POPF) is the most common complication following PD and is associated with delayed gastric emptying, intraabdominal abscess and hemorrhage, and superimposed infection and sepsis, increasing the length of stay and even leading to reoperation in some cases [9,10,11]. Reducing the rate of POPF after PD is a serious challenge for clinicians.
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