Risk Factors For Perioperative Complications Of Laparoscopic Pancreaticoduodenectomy(A Single-center Retrospective Study)

ObjectiveBased on the perioperative clinical data of 357 patients who underwent laparoscopic pancreatoduodenectomy(LPD),we intend to analyze the risk factors for the occurrence of postoperative pancreatic fistula,postoperative bleeding,and postoperative abdominal infection,to discuss their clinical significance,and to improve clinicians’understanding of the perioperative complications of LPD in order to reduce the incidence of LPD complications and improve surgical safety.MethodsThe perioperative clinical data related to 357 patients with LPD completed at Hunan Provincial People’s Hospital from May 2011 to December 2019 were retrospectively analyzed,including patients’gender,age,body mass index,comorbidities(diabetes,hypertension,coronary heart disease,etc.),Ca19-9,Ca125,ASA classification,operation time,intraoperative bleeding,pancreatic texture,pancreatic duct diameter,postoperative activity time,feeding time,postoperative complications(postoperative pancreatic fistula,postoperative bile leak,postoperative bleeding,postoperative abdominal infection,postoperative delayed gastrointestinal emptying,etc.),Re-operation rate,In-hospital mortality,and postoperative hospitalization days.Selected clinical variables were analyzed separately for risk factors for postoperative complications such as postoperative pancreatic fistula,postoperative bleeding,and postoperative abdominal infection(clinical indicators that were statistically significant after univariate analysis were included in the multi-factor logistic regression for further analysis,and differences were determined to be statistically significant at P<0.05).ResultsA total of 118(33%)postoperative complications occurred in 357 patients,52(14.6%)pancreatic fistulas,including 39(11%)grade B pancreatic fistulas,13(3.6%)grade C pancreatic fistulas;54(15.1%)postoperative hemorrhages,including 22(6.2%)grade A,27(7.5%)grade B and 5(1.4%)grade C;11(3.1%)biliary leaks,46(12.9%)abdominal infections,5(1.4%)delayed gastrointestinal emptying,wound infections 3(0.8%),23(6.4%)reoperations,and 9(2.5%)in-hospital deaths occurred.The mean operative time was 290.89±58.12 min,the mean intraoperative bleeding was 170.23±145.56 ml,the mean postoperative time to start walking was 3.54±2.13 days,the mean postoperative time to eat was 4.24±2.56 days,the mean postoperative time to anal discharge was 3.12±1.07 days,and the mean postoperative hospital stay was 18.7±9.9 days.Univariate analysis showed BMI>24Kg/m~2,pancreatic duct diameter<3mm,soft pancreatic texture,postoperative bleeding,postoperative bile leak,postoperative abdominal infection were significantly correlated with postoperative pancreatic fistula.Combined hypertension,postoperative pancreatic fistula,postoperative bile leak,and postoperative abdominal infection were significantly correlated with postoperative bleeding.Combined diabetes mellitus,operative time>300 min,postoperative pancreatic fistula,and postoperative bleeding were significantly associated with postoperative abdominal infection.Multifactorial logistic regression analysis revealed that BMI>24 Kg/m~2(OR=1.733,95%CI:1.212-4.228),soft pancreatic texture(OR=3.232,95%CI:3.234-11.487),and pancreatic duct diameter≤3 mm(OR=5.677,95%CI:2.024-15.917)were independent risk factors for postoperative pancreatic fistula.Hypertension(OR=2.874,95%CI:1.470-5.618),postoperative pancreatic fistula(OR=5.458,95%CI:1.807-16.486),and postoperative abdominal infection(OR=2.614,95%CI:1.563-12.176)were independent risk factors for the occurrence of postoperative bleeding.Diabetes mellitus(OR=2.312,95%CI:1.824-2.931),postoperative pancreatic fistula(OR=8.375,95%CI:5.181-13.537),and postoperative bleeding(OR=1.988,95%CI:1.118-5.981)were independent risk factors for the development of postoperative abdominal infection.Conclusion1.BMI>24Kg/m~2,soft pancreatic texture,and pancreatic duct diameter≤3mm were independent risk factors for postoperative pancreatic fistula;combined hypertension,postoperative pancreatic fistula,and postoperative abdominal infection were independent risk factors for postoperative bleeding;combined diabetes,postoperative pancreatic fistula,and postoperative bleeding were independent risk factors for postoperative abdominal infection.2.In patients with combined hypertension and diabetes mellitus,perioperative evaluation and management should be strengthened;postoperative patients with soft pancreas and pancreatic duct diameter≤3 mm should be alerted to the possibility of pancreatic fistula,the nature of drainage fluid and amylase test of drainage fluid should be paid attention to;postoperative pancreatic fistula,postoperative bleeding and postoperative abdominal infection are closely related,and should be detected early and treated actively to avoid deterioration of the disease.