Risk Factors For Early Postoperative Complications Following Pancreaticoduodenectomy

Background: The pancreaticoduodenectomy(PD),also known as Whipple procedure,is commonly used to treat benign and malignant tumors invading Vater’s ampulla,lower common bile duct,pancreatic head and duodenum.The surgery is difficult with high incidence of postoperative complications,which seriously affects the postoperative recovery of patients and increase hospital cost.This research mainly analyzes the risk factors of early complications including postoperative pancreatic fistula(POPF)and delayed gastric emptying(DGE),and discusses the potential relationship between them.Methods: Between January 2011 and October 2020,data from 139 patients who underwent pancreaticoduodenectomy in the Zhongshan Hospital Xiamen University were collected retrospectively.Preoperative clinical indicators,intraoperative and postoperative pathological results were examined with univariate analysis and multivariate logistic regression analysis to confirm the independent risk factors of early postoperative complications.Then,kendall tau rank correlation coefficient was used to compare the commonality and potential relationship between pancreatic fistula and delayed gastric emptying.Results: Among the 139 cases who underwent pancreaticoduodenectomy,39 of them(28.06%)suffered postoperative pancreatic fistula.Clinically relevant delayed gastric emptying occurred in 44 cases(31.65%).Univariate analysis and multivariate analysis showed that albumin and residual pancreatic texture were common risk factors for postoperative pancreatic fistula(p=0.037,p=0.000)and clinically relevant delayed gastric emptying(p=0.020,p=0.042).Distant invasion of malignant tumor(p=0.005)and traditional insertion pancreaticojejunostomy(p=0.006)may be independent risk factors for clinically relevant delayed gastric emptying.Postoperative pancreatic fistula was correlated with biliary fistula,anastomotic fistula,abdominal infection and other complications(p< 0.05).Biochemical leakage or pancreatic fistula was significantly associated with delayed gastric emptying(Kendallr =0.238,p=0.001).Conclusion: Postoperative pancreatic fistula and delayed gastric emptying are still serious early complications with high incidence,affecting the health recovery of patients after PD,and there is a significant correlation between the two.For patients with risk factors,perioperative whole-course management should be adopted to reduce the incidence of early complications.