Visceral Obesity and Open Passive Drainage Increase the Risk of Pancreatic Fistula Following Distal Pancreatectomy

BackgroundThe predictive risk factors of clinically relevant pancreatic fistula (CR-PF) following distal pancreatectomy (DP) remain to be identified.MethodsThis is a retrospective cohort analysis of a single-institution database of patients undergoing DP, taking into account usual demographic, operative, and pathologic variables and visceral fat area (VFA), total muscle area (TMA), and surface muscle index (SMI) measured on preoperative CT scan. The primary end point was CR-PF. All variables associated with a p value <0.05 on univariate analysis were included in a logistic regression model for multivariate analysis.ResultsFrom 2012 to 2016, 208 patients operated by 4 pancreatic surgeons underwent DP including 32 (15%) who developed CR-PF. Risk factors of CR-PF on univariate analysis were: BMI 25kg/m(2) (p=0.050), VFA 92cm(2) (p=0.006), laparotomy (p=0.023), main pancreatic duct dilatation (p=0.035), open passive drainage (versus closed suction drainage) (p=0.001), and blood loss 225ml (p=0.001). Sarcopenia did not influence the risk of CR-PF (p=0.076). On multivariate analysis, VFA 92cm(2) (OR 3.14; IC 95% (1.18-8.31), p=0.022), blood loss 225ml (OR: 2.72; IC 95% (1.06-6.96), p=0.037), and open passive drainage (OR 3.72; IC 95% (1.40-9.87) p=0.008) were three independent predictive factors of CR-PF. A CR-PF risk score was developed, predicting a 0% risk of CR-PF when no risk factors were present and a 39% risk when the 3 risk factors were present.ConclusionsVisceral obesity, blood loss 225ml and open passive drainage significantly increase the risk of CR-PF following DP.