Predictive Factors Associated With Postoperative Pancreatic Fistula Following Distal Pancreatectomy

Objective : Distal pancreatectomy(DP)is the standard procedure performed for lesions in the body or tail of the pancreas.Postoperative pancreatic fistula(POPF)is one of the most serious complications following DP.DP used to be considered a small and uncomplicated procedure,which lead to strides in understanding POPF following DP have lagged behind pancreaticoduodenectomy.Although mortality from these procedures has decreased in the past decades,the rate of POPF still remains high.The aim of this study was to identify risk factors associated with POPF after DP.Methods:A retrospective review of consecutive series of patients who had undergone DP between January 2016 and October 2018 at a single institution was conducted.Patient demographic data,perioperative data and clinicopathological parameters were analyzed to evaluate their correlation with the incidence of POPF using univariate and multivariate models.POPFs were defined by 2016 International Study Group of Pancreatic surgery criteria.Results : A total of 211 consecutive patients underwent PD were identified in this study.The overall pancreatic fistula rate was 15.6%(33/211)and no 30-day or 90-day mortality was happened.Four predictors were independently associated with POPF: soft pancreatic texture(OR: 4.23,95% CI: 1.71-10.45,P =0.002),longer operating time(OR: 4.18,95% CI: 1.67-10.46,P =0.002),higher difference of albumin(OR: 6.41,95% CI: 2.40-17.08,P <0.001),and history of cardiovascular disease(OR: 5.05,95% CI: 1.97-13.01,P =0.001).Conclusion:Although DP can be performed with a low rate of mortality,POPF remains a common complication.Pancreatic texture,operating time and difference of albumin,and cardiovascular disease were found to affect this risk in this study.Risk prediction as well as fistula mitigation strategies for distal pancreatectomy should be further studied and evaluated in large-scale and multicenter clinical trials.