Predictive Risk Factors for Clinically Related Pancreatic Fistula After Pancreaticoduodenectomy: Analysis of 248 Patients

Objective: Postoperative pancreatic fistula ( POPF) affects 13-50% of patients undergoing pancreaticoduodenectomy (PD), and remains the main source of post-PD morbidity and mortality. Therefore, determining predictive risk factors for POPF remains popular today. This study aimed to determine the predictive risk factors for clinically related postoperative pancreatic fistula (CR-POPF) in the preoperative and early postoperative period in patients that underwent PD. Methods: This is a retrospective study involving 248 patients who underwent PD between January 2015 and December 2019 in our center. We compared the groups that did and did not develop CR-POPF. We determined the risk factors affecting CR-POPF by stepwise logistic regression analysis. Results: 141 (56.8%) of the patients included in the study were male, and the median age was 63 (56-70)/ year. The CR-POPF rate was 18.1%. We found a statistically significant difference (p <0.05) in the following parameters: diabetes, smoking, preoperative leukocyte, preoperative neutrophil, postoperative first day (POD1) amylase, POD1 AST, POD1 ALT, POD1 CRP, POD1 lymphocyte-CRP ratio (LCR), postoperative third day ( POD3) lymphocyte, POD3 CRP, in POD3 neutrophil-lymphocyte ratio, POD3 platelet-lymphocyte ratio (PLR), POD3 AST-ALT ratio, POD3 LCR, surgeon experience, incision type, Wirsung diameter, pancreatic tissue and operation time. In the stepwise logistic regression model, we found POD1 AST, POD3 CRP, POD3 TLR, diabetes, surgeon experience, and Wirsung diameter as predictive risk factors. Conclusions: Despite some new methods to reduce the occurrence of POPF, the expected improvement in POPF rates is elusive. Predictive risk factors for POPF may also vary because the response of patients to trauma varies and the postoperative period is very dynamic. In our study, we found POD1 AST, POD3 CRP, POD3 TLR, diabetes, surgeon experience and Wirsung diameter as predictive risk factors for CR-POPF.