Risk factors for postoperative pancreatic fistula: Analysis of 539 successive cases of pancreaticoduodenectomy

Table 1 Criteria utilized to grade postoperative pancreatic fistula

Grade	A	B	C
Clinical conditions	Well	Often well	Ill appearing/bad
Specific treatment1	No	Yes/no	Yes
US/CT (if obtained)	Negative	Negative/positive	Positive
Persistent drainage (after 3 wk)2	No	Usually yes	Yes
Reoperation	No	No	Yes
Death related to POPF	No	No	Possibly yes
Signs of infection	No	Yes	Yes
Sepsis	No	No	Yes
Readmission	No	Yes/no	Yes/no

¹Partial (peripheral) or total parenteral nutrition, antibiotics, enteral nutrition, somatostatin analogue, and/or minimally invasive drainage;

²With or without a drain in situ. CT: Computed tomography; POPF: Postoperative pancreatic fistula; US: Ultrasonography.

Table 2 Disease composition

Pathological type	n
Pancreatic head cancer	126
Neuroendocrine tumor of the pancreatic head	12
Benign tumor of the pancreatic head	12
Solid pseudopapillary tumor of the pancreatic head	16
Autoimmune pancreatitis	3
Chronic pancreatitis	11
Lower bile duct cancer	145
Benign tumor of the lower bile duct	13
Ampullary cancer	76
Benign ampullary tumor	6
Duodenal stromal tumor	7
Duodenal cancer	10
Chronic mucosal inflammation of the descending duodenum	3
Duodenal papillary cancer	90
Benign duodenal papillary tumor	6
Duodenal papillary neuroendocrine tumor	3
Total	539

Table 3 Risk factors for pancreatic fistula according to univariate analysis

Variable	POPF occurrence
	Yes	No	χ2	P value
Sex			7.042	0.008
Male	186	157
Female	83	113
Age (yr)			2.132	0.144
≥ 60	99	116
< 60	170	154
Body mass index (kg/m2)			5.066	0.024
> 25	85	62
≤ 25	184	208
Hypertension			0.938	0.332
Yes	62	53
No	207	217
Diabetes mellitus			3.941	0.047
Yes	29	45
No	240	225
Drinking history			0.169	0.681
Yes	77	73
No	193	197
Smoking history			1.426	0.232
Yes	78	66
No	191	204
Epigastrium surgery			0.640	0.424
Yes	18	23
No	251	247
Preoperative biliary drainage			0.406	0.524
Yes	65	59
No	204	211
Preoperative total bilirubin (μmol/L)			0.378	0.539
> 171	73	67
≤ 171	196	203
Serum albumin (g/L)			0.000	0.985
< 35	41	41
≥ 35	228	229
Blood glucose (mmol/L)			9.157	0.002
≤ 6.0	190	157
> 6.0	79	113
Pancreaticojejunostomy			20.323	0.000
Double-layer mucosa-to-mucosa	229	169
Single-layer mucosa-to-mucosa	50	91
Blood loss (mL)			0.134	0.715
> 600	34	37
≤ 600	235	225
Pancreatic duct diameter (mm)			19.687	0.000
≤ 3	185	135
> 3	84	135
Pylorus-preserving			0.017	0.897
Yes	131	133
No	138	137
Pancreatic duct drainage			0.016	0.900
External	64	63
Enteral	205	207
Intraoperative blood infusion			1.310	0.252
Yes	36	46
No	233	224
Operative time (min)			0.299	0.584
> 300	196	191
≤ 300	73	79
Braun anastomosis			2.274	0.132
Yes	78	94
No	192	175
Pancreatic texture			29.330	0.000
Soft	228	174
Hard	41	96

Table 4 Logistic regression for the predictors of pancreatic fistula following pancreaticoduodenectomy

Variable	B	SE	Wals	P value	OR	95%CI
Sex	0.579	0.196	8.688	0.003	1.784	1.214-2.622
Body mass index	0.518	0.213	5.941	0.015	1.679	1.107-2.546
Pancreaticojejunostomy	0.743	0.217	11.723	0.001	2.102	1.374-3.216
Pancreatic duct diameter	0.724	0.192	14.254	0.000	2.062	1.416-3.003
Pancreatic texture	1.115	0.227	24.102	0.000	3.048	1.953-4.757