Retrospective investigation of risk factors for pancreatic fistula development after pancreaticoduodenectomy.

BACKGROUND: This study aimed to compare and analyze risk factors for pancreatic fistula following pancreaticoduodenectomy (PD) using different definition criteria, and to develop a predictive model for standardized pancreatic fistula risk assessment. AIM: To identify and compare risk factors for postoperative pancreatic fistula (POPF) following PD using both the 2005 International Study Group of Pancreatic Fistula and updated 2016 International Study Group on Pancreatic Surgery diagnostic criteria, and to develop a clinically applicable predictive model based on objective preoperative parameters for standardized pancreatic fistula risk assessment and perioperative management optimization. METHODS: We conducted a retrospective analysis of 303 patients who underwent PD at CR&WISCO General Hospital between January 2017 and May 2023. POPF cases were classified according to both previous and updated diagnostic standards. For statistical analysis, we employed t-tests or Mann-Whitney U tests for continuous variables and χ 2 tests for categorical data. To identify risk factors associated with POPF under both classification systems, we performed univariate and multivariate logistic regression analyses. RESULTS: Univariate analysis identified several factors associated with POPF: Main pancreatic duct diameter (χ 2 = 31.641, P < 0.001), main pancreatic duct index (χ 2 = 52.777, P < 0.001), portal vein invasion (χ 2 = 6.259, P = 0.012), intra-abdominal fat thickness (χ 2 = 7.665, P = 0.006), preoperative biliary drainage (χ 2 = 5.999, P = 0.014), pancreatic characteristics (χ 2 = 5.544, P = 0.019), pancreatic resection margin thickness (t = 2.055, P = 0.032), pancreatic computed tomography (CT) value (t = -3.224, P = 0.002), and preoperative blood amylase level (Z = -2.099, P = 0.036). Multivariate logistic regression identified three independent risk factors: Main pancreatic duct index [odds ratio (OR) = 0.000, 95% confidence interval (CI): 0.000-0.011], pancreatic cancer [OR = 4.843, 95%CI: 1.285-18.254], and pancreatic CT value [OR = 0.869, 95%CI: 0.806-0.937] (all P < 0.05). CONCLUSION: The main pancreatic duct index and pancreatic CT value are strongly correlated with pancreatic fistula development after PD.