Characterization of Pancreatic Fistula after Post-pancreatectomy Acute Pancreatitis

Haoda Chen; Weishen Wang; Ningzhen Fu; Wentao Xia; Hongzhe Li; Yuchen Ji; Jingyu Zhong; Jiancheng Wang; Xiaxing Deng; Zhiwei Xu; Yuanchi Weng; Baiyong Shen

doi:10.1097/SLA.0000000000006277

Characterization of Pancreatic Fistula after Post-pancreatectomy Acute Pancreatitis

Ann Surg. 2024 Mar 19. doi: 10.1097/SLA.0000000000006277. Online ahead of print.

Authors

Affiliations

¹ Department of General Surgery, Pancreatic Disease Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
² Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

PMID: 38501245
DOI: 10.1097/SLA.0000000000006277

Abstract

Objective: This study aimed to investigate the clinical significance and risk factors of postoperative pancreatic fistula (POPF) after post-pancreatectomy acute pancreatitis (PPAP) in patients who underwent pancreaticoduodenectomy (PD).

Summary background data: PPAP has been recognized as a critical factor in the pathophysiology of POPF after PD.

Methods: A total of 817 consecutive patients who underwent elective PD between January 2020 and June 2022 were included. PPAP and POPF were defined in accordance with the International Study Group for Pancreatic Surgery (ISGPS) definitions. Multivariate logistic analyses were performed to investigate the risk factors for POPF. Comparisons between PPAP-associated POPF and non-PPAP-associated POPF were made to further characterize this intriguing complication.

Results: Overall, 159 (19.5%) patients developed POPF after PD, of which 73 (45.9%) occurred following PPAP, and the remaining 86 (54.1%) had non-PPAP-associated POPF. Patients with PPAP-associated POPF experienced significantly higher morbidity than patients without POPF. Multivariate analyses revealed distinct risk factors for each POPF type. For PPAP-associated POPF, independent risk factors included estimated blood loss >200 mL (OR 1.93), MPD ≤3 cm (OR 2.88), and soft pancreatic texture (OR 2.01), largely overlapping with FRS (Fistula Risk Score) elements. On the other hand, non-PPAP-associated POPF was associated with age >65 years (OR 1.95), male (OR 2.10), and MPD ≤3 cm (OR 2.57). Notably, among patients with PPAP, the incidence of POPF consistently hovered around 50% regardless of the FRS stratification.

Conclusions: PPAP-associated POPF presents as a distinct pathophysiology in the development of POPF after PD, potentially opening doors for future prevention strategies targeting the early postoperative period.