Risk factors analysis of pancreatic fistula after pancreaticoduodenectomy

Objective To investigate the risk factors of pancreatic fistula after pancreaticoduodenectomy. Methods The retrospective case-control study was conducted. The clinicopathological data of 310 patients who underwent pancreaticoduodenectomy in the First Affiliated Hospital of Sun Yat-Sen University between January 2011 and December 2015 were collected. Observation indicators: (1) follow-up situations; (2) risk factors analysis of pancreatic fistula after pancreaticoduodenectomy. Follow-up using outpatient examination and telephone interview was performed to detect occurrence of pancreatic fistula and pancreatic fistula-induced rehospitalization or death up to June 2016. The univariate and multivariate analyses were respectively done using the chi-square test and logistic regression model. Results (1) Follow-up situations: 310 patients were followed up for 6-60 months, with a median time of 31 months. During the follow-up, 65 patients were complicated with pancreatic fistula, including 59 in grade B and 6 in grade C. Twenty-four patients received conservative treatment, and 41 received B ultrasound-guided catheter drainage. Of 65 patients, 63 were improved and then discharged form hospital; 2 in grade C of pancreatic fistula died of pancreatic fistula-related complications. (2) Risk factors analysis of pancreatic fistula after pancreaticoduodenectomy: univariate analysis showed that combined hypertension, cases with pancreaticoduodenectomy, operation time and pancreaticojejunostomy method were related factors affecting pancreatic fistula after pancreaticoduodenectomy (χ2=5.986, 13.006, 9.025, 21.561, P 6 hours and end-to-end telescopic pancreatico-jejunostomy or binding pancreaticojejunostomy were independent risk factors affecting pancreatic fistula after pancreaticoduodenectomy (Odds ratio=2.465, 1.880, 2.719, 6.190, 95% confidence interval: 1.253-4.850, 1.025-3.448, 1.254-5.894, 2.309-16.592, P<0.05). Conclusion The combined hypertension, operation time > 6 hours and end-to-end telescopic pancreaticojejunostomy or binding pancreaticojejunostomy are independent risk factors affecting pancreatic fistula after pancreaticoduodenectomy. Key words: Pancreatic diseases; Pancreatic neoplasms; Pancreatic cancer; Pancreaticoduodenectomy; Pancreatic fistula; Pancreaticojejunostomy; Risk factors