Risk Analysis of Pancreatic Fistula After Pancreatic Head Resection

Abstract

PANCREATIC resection provides the only chance for cure and long-term survival in patients with periampullary carcinoma. In the past, pancreatoduodenectomy (PD) was uncommonly performed because of a high operative mortality and almost no long-term survivors. With the recent advances in surgical techniques and improvements in perioperative care, the mortality rate after PD has drastically decreased to less than 5%.^1-5 The procedure has been performed extensively, even in patients with a variety of benign disorders of the pancreas. Despite this marked reduction in mortality after PD, leakage of the pancreatojejunostomy remains a challenge to surgeons.^1-5 The incidence of pancreatic fistula and/or pancreatic anastomotic leakage after PD has been reported to be 8% to 19% in most series.^1-10 Once the anastomotic leakage occurs, the associated mortality rate is very high (8%-40%).^6-10 Some previous reports described risk factors for pancreatic fistula, including age older than 65 years,⁸ a small pancreatic duct,⁹ soft or normal pancreatic parenchyma,^10,11 large-volume intraoperative blood loss,⁹ presence of jaundice,⁸ and operative technique.¹² However, few reports have extensively analyzed multiple risk factors. In this study, we retrospectively reviewed 27 clinical variables in 62 patients who had undergone pancreatic head resection with pancreatojejunostomy to elucidate risk factors for pancreatic fistula.