Factors affecting healing time of postoperative pancreatic fistula in patients undergoing pancreaticoduodenectomy

Abstract

Clinically-relevant postoperative pancreatic fistula (CR-POPF) is one of the most serious complications following pancreaticoduodenectomy. While many investigators have studied risk factors for the development of CR-POPF, few studies have focused on time needed for CR-POPF healing in patients who develop this complication. The present study enrolled 38 cases in whom CR-POPF developed following pancreaticoduodenectomy (24.1%) out of 158 cases receiving treatment with pancreaticoduodenectomy between 2009 and 2017 for periampullary diseases. CR-POPF healing time, was defined as the length of time from the day of pancreaticoduodenectomy to the day when intraabdominal drainage tubes used for CR-POPF treatment were removed, were assessed and factors affecting the healing time were investigated. The mean CR-POPF healing time was 40.2±21.7 days (median; 35 days, range; 10-110 days). Univariate analysis demonstrated a significant relationship between CP-POPE healing time and sex, intraoperative blood loss, and type of pancreaticojejunostomy procedure. Multivariate Cox regression analysis using these factors revealed that intraoperative blood loss and type of pancreaticojejunostomy procedure were significant independent factors for the length of CR-POPF healing time. CR-POPF healing time following pancreaticoduodenectomy was 40.2±21.7 days on average (median, 35 days; range 10-110 days). Intraoperative blood loss and type of pancreaticojejunostomy procedure were identified as significant independent factors associated with the healing time. These results will help with earlier recovery from CR-POPF.

Keywords: intraoperative blood loss; modified Blumgart anastomosis; pancreatic fistula.

Figure 1.

Time needed for CR-POPF healing in individual cases. The cases (#1-38) were arranged by the length of the healing time. CR-POPF, clinically relevant postoperative pancreatic fistula.

Figure 2.

Cumulative CR-POPF healing rate following surgery. The rates were calculated with the Kaplan-Meier method and described graphically with stratification by significant factors; (A) sex, (B) intraoperative blood loss, and (C) procedure used for pancreaticojejunostomy. (D) The rates calculated with the Kaplan-Meier method were described with liners with a proposed stratification; Group I included patients with smaller intraoperative blood loss (<696 ml) and use of modified Blumgart anastomosis for the reconstruction, Group II included those with larger intraoperative blood loss (/≥696 ml) and use of modified Blumgart anastomosis and those with smaller intraoperative blood loss (<696 ml) and use of Kakita method, and Group III included those with larger intraoperative blood loss (/≥696 ml) and use of Kakita method. CR-POPF, clinically relevant postoperative pancreatic fistula.