Investigating risk factors occurring to postoperative pancreatic fistula after proximal pancreaticoduodenectomy

PurposePostoperative pancreatic fistula after (POPF) proximal pancreaticoduodenectomy (PPD) is a common complication reported between 0% and 7%. Pancreatic fistula generally occuring due to anastomosis leak is the most important cause of mortality and morbidity of pancreatoduodenectomy.International Study Group on Pancreatic Fistula (ISGPF) defined POPF as 3 or more times higher levels of drain amilaz values compared to serum amilaz levels and seperated into 3 groups as Group A, Group B and Group C. Group B-C is mentioned to be clinically significantİn this study we aimed to determine the risk factors for POPF which is the most important and common complication after PPD.MATERIAL and METHODIn this study information of 204 patients went under proximal pancreaticoduodenectomy between March 1995 and August 2011 in Dokuz Eylul University School of Medicine, Department of General Surgery was collected retrospectively.Age, sex, complaints on presentation, ASA score, labarotory, preoperative diagnose and any approches for diagnose and treatment such as ERCP, PTC, percutaneous biliary drainage, operation time, perioperative blood transfusion, bleeding volume, diameter of Wirsung, solidity of pancreas, accompanying portal ven resection, postoperative pancreatic fistula, postoperative pathologic examination, preoperative and postoperative clinical notes, operation notes, radiologic examinations were assesed.Data of patients were analyzed with SPSS for Windows 15.0.RESULTUnivariate analysis revealed Wirsung diameter under 3 mm (p=0,004) and soft pancreatic tissue (p<0,001) are significantly increase POPF in all groups.Univariate analysis of group B and C showed Wirsung diameter under 3 mm (p=0,004) and soft pancreatic tissue (p<0,001) and ethiology except tumor (p=0.018) are significantly increase.Multivariate analysis revealed that soft pancreatic tissue is statistically significant for both POPF(Group A-B-C) (Odds ratio 2,018, confidence interval 2,993-18,932, p<0,001) and Group B and C pancreatic fistula (Odds ratio 2,763, confidence interval 3,906-65,352, p<0,001) and it is the most important risk factor.As a conclusion patients carrying high risk of pancreatic fistula may be provided preoperatively so that mortality and morbidity may be decreased.