Pancreatic fistula risk assessment after distal pancreatectomy: a retrospective controlled study

• Published in: Kubanskiĭ nauchnyĭ medit︠s︡inskiĭ vestnik Vol. 28; no. 2; pp. 33 - 45
• Main Authors: Drozdov, E. S., Topolnitskiy, E. B., Klokov, S. S., Dibina, T. V.
• Format: Journal Article
• Language: English
• Published: Ministry of Healthcare of the Russian Federation. “Kuban State Medical University” 15-04-2021
• Subjects: distal pancreatectomy; pancreatic fistula; postoperative complications; risk factors
• ISSN: 1608-6228; 2541-9544
• DOI: 10.25207/1608-6228-2021-28-2-33-45

Background. 
Despite declining mortality, postoperative pancreatic fistula (PPF) remains a common complication of distal pancreatic resection surgery challenging to clinical prediction.
Objectives. 
Prognostic analysis of the postoperative pancreatic fistula risk factors in patients with previous distal pancreatectomy.
Methods. 
A retrospective controlled assay enrolled 107 patients, including 63 (58.9%) male and 44 (41.1%) female patients. All patients underwent distal pancreatectomy followed by a morphological examination of resected material. All patients had a general and biochemical blood panel profiling. Pancreatic tissue density at a putative resection zone was assessed with computed tomography. The patients were allocated to two cohorts: (1) not developing PPF (77 patients) and (2) having postoperative PPF complications (30 patients.
Results. 
No statistically significant differences by age, gender, ASA and BMI scores were observed in study cohorts. Multivariate analysis revealed a statistically significant correlation of the PPF rate with the following factors: main pancreatic duct diameter <3 mm (odds ratio (OR) 1.02, 95% confidence interval (CI) 1.01–1.05, 
p
 = 0.01), pancreatic density at putative resection zone <30 HU in CT (OR 3.18, 95% CI 1.38–7.74, p < 0.01) and differential albumin of postoperative day 1 vs. pre-surgery >14 g/L (OR 3.13, 95% CI 1.19–8.24, 
p
 < 0.01).
Conclusion. 
A main pancreatic duct diameter <3 mm, pancreatic density at putative resection zone <30 HU in CT and differential albumin of postoperative day 1 vs. pre-surgery >14 g/L are independent risk factors of postoperative fistulae.