Huang L, Li QL, Yu QS, Peng H, Zhen Z, Zhang Q, Shen Y. Predicting pancreatic fistula post-splenectomy in cirrhosis with splenomegaly: Risk factors and nomogram validation. World J Hepatol 2026; 18(3): 115108 [DOI: 10.4254/wjh.v18.i3.115108]
Corresponding Author of This Article
Long Huang, MD, Chief Doctor, Professor, Department of Hepatobiliary Surgery, The First Hospital Affiliated to Anhui University of Traditional Chinese Medicine, No. 117 Meishan Road, Hefei 230031, Anhui Province, China. huanglong658@163.com
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Gastroenterology & Hepatology
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Retrospective Study
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Mar 27, 2026 (publication date) through Mar 26, 2026
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World Journal of Hepatology
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1948-5182
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Huang L, Li QL, Yu QS, Peng H, Zhen Z, Zhang Q, Shen Y. Predicting pancreatic fistula post-splenectomy in cirrhosis with splenomegaly: Risk factors and nomogram validation. World J Hepatol 2026; 18(3): 115108 [DOI: 10.4254/wjh.v18.i3.115108]
World J Hepatol. Mar 27, 2026; 18(3): 115108 Published online Mar 27, 2026. doi: 10.4254/wjh.v18.i3.115108
Predicting pancreatic fistula post-splenectomy in cirrhosis with splenomegaly: Risk factors and nomogram validation
Long Huang, Qing-Lin Li, Qing-Sheng Yu, Hui Peng, Zhou Zhen, Qi Zhang, Yi Shen
Long Huang, Qi Zhang, Department of Hepatobiliary Surgery, The First Hospital Affiliated to Anhui University of Traditional Chinese Medicine, Hefei 230031, Anhui Province, China
Qing-Lin Li, Key Laboratory of Xin’an Medicine, Anhui University of Traditional Chinese Medicine, Hefei 230031, Anhui Province, China
Qing-Sheng Yu, Hui Peng, Department of Hepatobiliary Surgery, Anhui University of Traditional Chinese Medicine, Hefei 230031, Anhui Province, China
Zhou Zhen, Department of Surgery, The Second Hospital Affiliated to Anhui University of Traditional Chinese Medicine, Hefei 230061, Anhui Province, China
Yi Shen, Department of Surgery, Anhui University of Traditional Chinese Medicine, Hefei 230031, Anhui Province, China
Author contributions: Huang L contributed to funding acquisition, project administration, writing-original draft preparation; Li QL contributed to conceptualization, methodology; Yu QS contributed to investigation, data curation; Peng H contributed to reviewing and editing; Zhen Z contributed to formal analysis; Zhang Q contributed to validation; Shen Y contributed to software operation. All authors have reviewed the manuscript.
Supported by Projects of Anhui Provincial Health Commission, No. AHWJ2023A30146; Scientific Research Projects in Anhui Provincial Colleges and Universities, No. 2024AH050959; and the Anhui Provincial Natural Science Foundation, No. 2408085MH222.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of the First Affiliated Hospital of the Anhui University of Chinese Medicine, approval No. 2024AH-30.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: If you request data for this study, please contact the corresponding author (Long Huang, huanglong658@163.com) (the raw data is shown in the Supplementary material).
Corresponding author: Long Huang, MD, Chief Doctor, Professor, Department of Hepatobiliary Surgery, The First Hospital Affiliated to Anhui University of Traditional Chinese Medicine, No. 117 Meishan Road, Hefei 230031, Anhui Province, China. huanglong658@163.com
Received: October 13, 2025 Revised: November 10, 2025 Accepted: January 7, 2026 Published online: March 27, 2026 Processing time: 169 Days and 17.7 Hours
Abstract
BACKGROUND
Clinically relevant postoperative pancreatic fistula (CR-POPF) is a critical complication of splenectomy, particularly in patients with cirrhosis, splenomegaly, and hypersplenism. However, there is a lack of comprehensive risk assessment models.
AIM
To identify independent risk factors for CR-POPF after splenectomy in this cohort and to develop a clinically useful predictive nomogram.
METHODS
This retrospective study included 186 patients who underwent splenectomy for cirrhotic splenomegaly with hypersplenism at our institution, between January 2019 and December 2024. PF was diagnosed and graded according to the 2016 International Study Group on Pancreatic Fistulas criteria. Univariate and multivariate least absolute shrinkage and selection operator-penalized logistic regression analyses were performed to identify independent risk factors. A nomogram was constructed based on these factors, and its performance was evaluated using the area under the receiver operating characteristic curve, calibration curves, and decision curve analysis.
RESULTS
Of the 186 patients, 21 developed biochemical leak, and 6 developed CR-POPF, including 4 grade B and 2 grade C. Multivariate least absolute shrinkage and selection operator-penalized logistic analysis revealed that body mass index (BMI) [odds ratio = 3.578, 95% confidence interval (CI): 1.156-11.080; P = 0.027] and splenic thickness (odds ratio = 1.250; 95%CI: 1.014-1.542; P = 0.037) were independent risk factors for CR-POPF. The nomogram integrating these factors demonstrated excellent discriminative ability (area under the receiver operating characteristic curve = 0.816, 95%CI: 0.500-0.993), good calibration (Hosmer-Lemeshow statistic = 0.027, degrees of freedom = 3, P = 0.999 > 0.05), and favorable clinical utility (positive net benefit across a threshold probability range of approximately 0% to 99% in the decision curve analysis). PF grade analysis showed significant differences in BMI and pancreatic texture (P < 0.05).
CONCLUSION
This study identified BMI and splenic thickness as independent risk factors for CR-POPF after splenectomy in patients with cirrhosis with splenomegaly. The developed nomogram provides a reliable tool for individualized risk prediction, facilitating targeted perioperative management to reduce CR-POPF incidence and improve patient outcomes.
Core Tip: This retrospective study included 186 cirrhotic patients with splenomegaly who underwent splenectomy. Through multivariate least absolute shrinkage and selection operator-penalized logistic regression, body mass index and splenic thickness were confirmed as independent risk factors for clinically relevant postoperative pancreatic fistula. The nomogram built on these factors achieved an area under the receiver operating characteristic curve of 0.816, providing reliable individualized perioperative risk prediction to cut clinically relevant postoperative pancreatic fistula occurrence and boost patient recovery.
