Yao L, Zhu K, Yuan J, Luo ZX, Huang WG. Retrospective investigation of risk factors for pancreatic fistula development after pancreaticoduodenectomy. World J Gastrointest Surg 2025; 17(10): 106685 [PMID: 41178877 DOI: 10.4240/wjgs.v17.i10.106685]
Corresponding Author of This Article
Lei Yao, Department of General Surgery, CR&WISCO General Hospital, No. 209 Metallurgical Avenue, Qingshan District, Wuhan 430080, Hubei Province, China. 15871707870@163.com
Research Domain of This Article
Gastroenterology & Hepatology
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Retrospective Study
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Oct 27, 2025 (publication date) through Nov 17, 2025
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World Journal of Gastrointestinal Surgery
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1948-9366
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Yao L, Zhu K, Yuan J, Luo ZX, Huang WG. Retrospective investigation of risk factors for pancreatic fistula development after pancreaticoduodenectomy. World J Gastrointest Surg 2025; 17(10): 106685 [PMID: 41178877 DOI: 10.4240/wjgs.v17.i10.106685]
World J Gastrointest Surg. Oct 27, 2025; 17(10): 106685 Published online Oct 27, 2025. doi: 10.4240/wjgs.v17.i10.106685
Retrospective investigation of risk factors for pancreatic fistula development after pancreaticoduodenectomy
Lei Yao, Kai Zhu, Jian Yuan, Zhao-Xia Luo, Wen-Guang Huang
Lei Yao, Kai Zhu, Jian Yuan, Zhao-Xia Luo, Wen-Guang Huang, Department of General Surgery, CR&WISCO General Hospital, Wuhan 430080, Hubei Province, China
Author contributions: Yao L contributed to the conceptualization, writing - original draft, and project administration; Yao L and Luo ZX contributed to the methodology; Yao L and Zhu K contributed to the formal analysis; Yao L, Zhu K, Yuan J, Luo ZX, and Huang WG contributed to the writing - review & editing; Yao L and Huang WG contributed to supervision; Zhu K contributed to data curation and statistical analysis; Yuan J and Luo ZX contributed to data collection and validation; Yuan J contributed to investigation; Luo ZX contributed to resources; Huang WG approved the final version to be published. All authors contributed to the study conception and design, read and approved the final manuscript, and agree to be accountable for all aspects of the work.
Institutional review board statement: This study was approved by the Medical Ethics Committee of CR&WISCO General Hospital (Approval No. CRWG2023R033J; Protocol Version: 23V1.0; Version Date: June 1, 2023. All procedures performed were in accordance with the ethical standards of the institutional research committee and the 1964 Helsinki Declaration and its later amendments.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Lei Yao, Department of General Surgery, CR&WISCO General Hospital, No. 209 Metallurgical Avenue, Qingshan District, Wuhan 430080, Hubei Province, China. 15871707870@163.com
Received: April 22, 2025 Revised: June 4, 2025 Accepted: September 3, 2025 Published online: October 27, 2025 Processing time: 184 Days and 22.8 Hours
Abstract
BACKGROUND
This study aimed to compare and analyze risk factors for pancreatic fistula following pancreaticoduodenectomy (PD) using different definition criteria, and to develop a predictive model for standardized pancreatic fistula risk assessment.
AIM
To identify and compare risk factors for postoperative pancreatic fistula (POPF) following PD using both the 2005 International Study Group of Pancreatic Fistula and updated 2016 International Study Group on Pancreatic Surgery diagnostic criteria, and to develop a clinically applicable predictive model based on objective preoperative parameters for standardized pancreatic fistula risk assessment and perioperative management optimization.
METHODS
We conducted a retrospective analysis of 303 patients who underwent PD at CR&WISCO General Hospital between January 2017 and May 2023. POPF cases were classified according to both previous and updated diagnostic standards. For statistical analysis, we employed t-tests or Mann-Whitney U tests for continuous variables and χ2 tests for categorical data. To identify risk factors associated with POPF under both classification systems, we performed univariate and multivariate logistic regression analyses.
RESULTS
Univariate analysis identified several factors associated with POPF: Main pancreatic duct diameter (χ2 = 31.641, P < 0.001), main pancreatic duct index (χ2 = 52.777, P < 0.001), portal vein invasion (χ2 = 6.259, P = 0.012), intra-abdominal fat thickness (χ2 = 7.665, P = 0.006), preoperative biliary drainage (χ2 = 5.999, P = 0.014), pancreatic characteristics (χ2 = 5.544, P = 0.019), pancreatic resection margin thickness (t = 2.055, P = 0.032), pancreatic computed tomography (CT) value (t = -3.224,P = 0.002), and preoperative blood amylase level (Z = -2.099, P = 0.036). Multivariate logistic regression identified three independent risk factors: Main pancreatic duct index [odds ratio (OR) = 0.000, 95% confidence interval (CI): 0.000-0.011], pancreatic cancer [OR = 4.843, 95%CI: 1.285-18.254], and pancreatic CT value [OR = 0.869, 95%CI: 0.806-0.937] (all P < 0.05).
CONCLUSION
The main pancreatic duct index and pancreatic CT value are strongly correlated with pancreatic fistula development after PD.
Core Tip: Postoperative pancreatic fistula remains a significant challenge after pancreaticoduodenectomy, impacting patient outcomes and healthcare costs. Recent advancements in diagnostic criteria have refined our understanding of risk factors, including the main pancreatic duct index, pancreatic computed tomography value, and tumor characteristics. Integrating these factors into predictive models helps identify high-risk patients early, allowing for targeted interventions and improved surgical outcomes. Adopting standardized grading systems ensures consistent reporting and enhances clinical decision-making. This study underscores the importance of combining clinical, radiological, and pathological data in postoperative pancreatic fistula risk assessment, ultimately guiding more personalized perioperative care strategies and reducing complication rates.
