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Risk factors for postoperative pancreatic fistulas after pancreaticoduodenectomy

Annotation. Despite the constant improvement of surgical techniques of the pancreaticoduodenectomies (PD) performing and patient management after the procedure, the number of postoperative complications remains high, reaching from 30 to 60%, depending on the center. Among them, the most important role is played by the postoperative pancreatic fistulas (POPF). The goal of the study was to establish the risk factors that influenced on development of the pancreatic fistulas in patients after PD. The retrospective study of 108 case histories of patients who underwent PD in the period from 2008 to 2021 at the Surgery Clinic No. 2 at the Dnipro Regional Hospital named after I.I. Mechnikov was executed. Correlation analysis was performed with the calculation of Spearman's rank correlation coefficients (ρ) in the MedCalc Statistical Software trial software package, version 17.4. POPF were detected in 19 out of 108 patients (17.6%): type A was observed in 7 (6.5%) cases, type B in 9 patients (8.3%), type C in 3 (2.8%) cases. Spearman's rank-order correlation test identified indicators that were significantly associated with an increased risk of POPF developing: body mass index of patients (rs =0.2; p≤0.05); presence of comorbidities (rs =0.2; p≤0.05); volume and severity of blood loss during surgery (rs =0.19; p≤0.05 and rs =0.21; p≤0.05); pancreas parenchyma density on the site of the anastomosis formation (determined by palpation during the operation) (rs =0.24; p≤0.05); the number of vessels bleeding on the transverse section of the pancreas (rs = -0.33; p≤0.05); diameter of the Wirsung duct (rs= -0.49; p≤0.05). With the help of ROC-analysis, the cut-off points of the indicators were established: diameter of the Wirsung duct ≤2.5 mm, number of vessels in the transverse section of the pancreas ≤1, BMI˃26.3 kg/m2, and blood loss during surgery ˃700 ml. Sensitivity, specificity and diagnostic efficiency of indicators were calculated, the best result had the Wirsung duct diameter (area under ROC-curve AUC=0,868, 95 % СІ (0,789 - 0,925), sensitivity – 100%, specificity – 74,2%, р<0,001). The significance of the factors influence on the result was assessed according to the multivariate logistic regression analysis. Thus, the significantly important risk factors for development of pancreatic fistulas after PD were: diameter of the Wirsung duct ≤2.5 mm, soft pancreatic parenchyma, number of vessels on the transverse section of the pancreas ≤1, BMI˃26.3 kg/m2 and blood loss during operation ˃700 ml.