Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jun 27, 2024; 16(6): 1609-1617
Published online Jun 27, 2024. doi: 10.4240/wjgs.v16.i6.1609
Identifying the risk factors for pancreatic fistula after laparoscopic pancreaticoduodenectomy in patients with pancreatic cancer
Hang Xu, Qing-Cai Meng, Jie Hua, Wei Wang
Hang Xu, Qing-Cai Meng, Jie Hua, Wei Wang, Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China
Hang Xu, Qing-Cai Meng, Jie Hua, Wei Wang, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
Author contributions: Xu H performed the research; Hua J contributed to the analysis; Wand W and Meng QC supervised the report.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of the Fudan University Shanghai Cancer Center (Approval No. 2008222-16).
Informed consent statement: All study participants or their legal guardians provided written informed consent for personal and medical data collection before study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The raw data used in this study can be obtained from the corresponding author upon 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: Wei Wang, MD, Professor, Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, No. 270 Dong’an Road, Xuhui District, Shanghai 200032, China. wangwei@fudanpci.org
Received: February 20, 2024
Revised: April 11, 2024
Accepted: April 26, 2024
Published online: June 27, 2024
Processing time: 130 Days and 17.8 Hours
Abstract
BACKGROUND

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.

AIM

To identify the risk factors for PF after laparoscopic pancreatoduodenectomy in patients with pancreatic cancer.

METHODS

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.

RESULTS

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.

CONCLUSION

BMI (> 24.91 kg/m²), hypertension, soft pancreatic texture, and operation time (> 414 min) are considered to be the risk factors for postoperative PF.

Keywords: Pancreatic cancer, Laparoscopy, Pancreaticoduodenectomy, Pancreatic fistula, Risk factors, Receiver-operating characteristic curve

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.