Published online Jun 27, 2024. doi: 10.4240/wjgs.v16.i6.1609
Revised: April 11, 2024
Accepted: April 26, 2024
Published online: June 27, 2024
Processing time: 131 Days and 1.3 Hours
Laparoscopic pancreaticoduodenectomy (LPD) is a surgical procedure for treating pancreatic cancer; however, the risk of complications remains high owing to the wide range of organs involved during the surgery and the difficulty of anastomosis. Pancreatic fistula (PF) is a major complication that not only increases the risk of postoperative infection and abdominal hemorrhage but may also cause multi-organ failure, which is a serious threat to the patient’s life. This study hypothesized the risk factors for PF after LPD.
To identify the risk factors for PF after laparoscopic pancreatoduodenectomy in patients with pancreatic cancer.
We retrospectively analyzed the data of 201 patients admitted to the Fudan University Shanghai Cancer Center between August 2022 and August 2023 who underwent LPD for pancreatic cancer. On the basis of the PF’s incidence (grades B and C), patients were categorized into the PF (n = 15) and non-PF groups (n = 186). Differences in general data, preoperative laboratory indicators, and surgery-related factors between the two groups were compared and analyzed using multifactorial logistic regression and receiver-operating characteristic (ROC) curve analyses.
The proportions of males, combined hypertension, soft pancreatic texture, and pancreatic duct diameter ≤ 3 mm; surgery time; body mass index (BMI); and amylase (Am) level in the drainage fluid on the first postoperative day (Am > 1069 U/L) were greater in the PF group than in the non-PF group (P < 0.05), whereas the preoperative monocyte count in the PF group was lower than that in the non-PF group (all P < 0.05). The logistic regression analysis revealed that BMI > 24.91 kg/m² [odds ratio (OR) =13.978, 95% confidence interval (CI): 1.886-103.581], hypertension (OR = 8.484, 95%CI: 1.22-58.994), soft pancreatic texture (OR = 42.015, 95%CI: 5.698-309.782), and operation time > 414 min (OR = 15.41, 95%CI: 1.63-145.674) were risk factors for the development of PF after LPD for pancreatic cancer (all P < 0.05). The areas under the ROC curve for BMI, hypertension, soft pancreatic texture, and time prediction of PF surgery were 0.655, 0.661, 0.873, and 0.758, respectively.
BMI (> 24.91 kg/m²), hypertension, soft pancreatic texture, and operation time (> 414 min) are considered to be the risk factors for postoperative PF.
Core Tip: Controlling the highly correlated risk factors of pancreatic fistula (PF) following laparoscopic pancreaticoduodenectomy (LPD) can decrease PF incidence. Although existing studies have confirmed that the occurrence of PF after LPD is influenced by various factors, including self-development and surgery-related factors, few studies have examined the factors influencing the development of PF after LPD in pancreatic cancer. Here, we analyzed the factors associated with the development of PF after LPD for pancreatic cancer and found that body mass index (> 24.91 kg/m²), hypertension, soft pancreatic texture, and operation time (> 414 min) were risk factors.