Operative risk factors for clinically relevant-postoperative pancreatic fistula after pancreaticoduodenectomy: a prospective multicenter cohort study

Abstract

Background Pancreatic fistula remains the most dangerous complication after pancreatoduodenectomy (PD). This study aimed to identify the operative risk factors for clinically relevant-postoperative pancreatic fistula (CR-POPF) after PD. Methods This prospective multicenter cohort study investigated the association between CR-POPF and operative risk factors in 107 patients who underwent PD at three tertiary centers from August 2017 to July 2022. Results The incidence of CR-POPF was 26.2%. With univariate analysis, soft pancreatic texture, pancreatic duct diameter (≤3 mm), right-sided pancreatic transection, absorbable suture, pancreatico-enteric anastomosis invagination technique, non-stented pancreatic drainage, internal pancreatic drainage, long anastomotic time (>40 min), and R1 resection margin were risk factors for CR-POPF. Multivariate analysis identified four independents risk factors for CR-POPF: (1) soft pancreatic texture (OR 0.219; 95% CI 0.061–0.792; P<0.021), (2) small main pancreatic duct diameter (OR 0.280; 95% CI 0.086–0.910; P<0.034), (3) right-sided pancreatic transection (OR 0.168; 95% CI 0.032–0.881; P<0.035), and (4) non-stented pancreatic drainage (OR 3.771; 95% CI 1.147–12.401; P<0.029). Conclusion The incidence of CR-POPF after PD is reduced significantly by left-sided pancreatic transection and pancreatic drainage. Soft pancreatic texture and small main pancreatic duct diameter are independent risk factors for CR-POPF, and clinically postoperative prophylactic measures should be implemented as soon as possible.