Predictive parameters that can be used preoperatively in evaluating postoperative complications of Whipple surgery

Pancreatic cancer is one of the most malignant cancers and ranks fourth in cancer-related deaths. Whipple surgery is the only curative option for pancreatic cancer, but it has high rates of mortality and morbidity. The early detection of postoperative complications is believed to reduce these rates. The study included 163 patients who underwent Whipple surgery between 2016 and 2021 for distal bile duct, duodenum, papilla, or pancreatic tumors. All patients were operated on by a single surgeon using the same technique. Postoperative complications such as delayed gastric emptying, pancreatic fistula, bile leakage, and infection were identified and their relationships with preoperative parameters were investigated. Postoperative pancreatic fistula (POPF) was detected in 22 patients, and bile leakage was detected in 9 patients. A statistically significant relationship was found between POPF and tumor density/remnant density ratio and lymph node count (p: 0.000 and p: 0.039, respectively). A significant relationship was also found between POPF and acidosis detected in the intraoperative blood gas (p: 0.011). Pancreatic fistula is one of the most feared complications of Whipple surgery, and although many techniques have been developed to minimize its incidence, none are perfect. No significant relationship was found between tumor or remnant pancreatic tissue density and POPF. This result is thought to be related to the non-homogeneity of the time elapsed until obtaining the image after IV contrast administration and other factors affecting contrast distribution, and it is thought that ratioing tumor and remnant pancreatic densities would minimize these problems. A significant relationship was found between the tumor/remnant pancreatic density ratio and POPF. This parameter, which can be examined preoperatively, is thought to be effective in the decision-making process for surgery. Complications following Whipple surgery can have a catastrophic course and can lead to mortality quickly. Therefore, early detection of complications and rapid intervention are of great importance. In this regard, we aimed to identify parameters that can be predictive of complications by examining preoperative parameters in patients undergoing Whipple surgery. Additional precautions may be useful to prevent POPF development in patients with high tumor/pancreatic density and other risk factors for POPF development.