Analysis Of Risk Factors For Postoperative Pancreatic Fistula After Pancreaticoduodenectomy

Objective: To explore the risk factors of postoperative pancreatic fistula(POPF)following pancreaticoduodenectomy.Methods: The data from 106 patients who underwent pancreaticoduodenectomy,including 62 males and 44 females,the youngest 21 years old,the oldest 79 years old,the average age of 57.9±11.6 years old,performed in the Fujian Provincial Hospital between March 2014 to November 2016 were retrospectively collected for analysis.All patients were improved preoperative routine examination,excluding heart,lung,liver,kidney and other vital organs damage.Child's technique(pancreaticojejunal anastomosis,biliary-jejunal anastomosis,and gastro-jejunal anastomosis in sequential order)was used for the gastrointestinal reconstruction.The methods used for pancreatic anastomosis included pancreatico-jejunostomy(including end-to-end,end-to-side)and pancreaticogastrostomy.Postoperative pancreatic fistula was diagnosed in strict accordance with two versions of definitions of pancreatic fistula from the International Study Group of Pancreatic Fistula and International Study Group on Pancreatic Surgery in 2005 and 2016,respectively.The risk factors for pancreatic fistula were analyzed by univariate analysis and multivariate logistic regression analysis.P<0.05 was considered statistically significant.Results: A total of 56(52.8%)cases of POPF and 24(22.6%)cases of CR-POPF occurred after pancreaticoduodenectomy,including 32(30.2%)cases of biochemical leak,17(16.0%)cases of grade B,and 7(6.6%)cases of grade C.Univariate analysis showed no significant correlation between POPF and the following factors: age,gender,BMI,preoperative jaundice,eigastrium surgery,hypertension,diabetes mellitus,preoperative total protein,preoperative albumin,postoperative hemoglobin,postoperative albumin,postoperative prealbumin,pancreatic duct drainage,intraoperative blood loss,operative time,combined vascular resection reconstruction and the methods of pancreatic anastomosis.Conversely,a significant correlation was observed between POPF and the following factor in univariate analysis and multivariate analysis: a soft pancreatic texture(OR=3.453,95%CI: 1.300 ~ 9.167,P=0.013),pancreatic duct diameter ?3 mm(OR=4.430,95%CI: 1.620 ~ 12.115,P=0.004),non-pancreatic head carcinoma/non-chronic pancreatitis(OR=3.057,95%CI:1.092~8.560,P=0.033).On the other hand,a significant correlation was found between POPF and the following factors: age ?60 years old,a soft pancreatic texture,pancreatic duct diameter ? 3mm,non-pancreatic head cancer/non-chronic pancreatitis in univariate analysis.Multivariate analysis showed age ?60 years old(OR=3.391,95%CI: 1.172~9.815,P=0.024),pancreatic duct diameter ? 3mm(OR=10.710,95%CI:0.475~8.675,P=0.027)are risk factors for CR-POPF.Conclusion: Our study demonstrated that CR-POPF are related to age ?60 years old and pancreatic duct diameter ? 3mm.The surgeon must take these risk factors into consideration when performing a pancreaticoduodenectomy.