To explore the risk factors of pancreatic fistula after pancreatoduodenectomy and its relationship with pancreatic fibrosis.

Retrospective analysis was made including 408 patients who underwent pancreaticoduodenectomy from January 2013 to December 2015 in Department of Hepatobiliary Surgery of the First Affiliated Hospital of Third Military Medical University. There were 274 males and females, aging from 14 to 82 years with an average age of 54.6 years. Postoperative pathological diagnosis: 285 cases with pancreatic ductal adenocarcinoma, 81 cases with gastrointestinal tumors, 13 cases with neuroendocrine tumors, 16 cases with inflammatory changes, 8 cases with pancreatic papillary tumors, 4 cases with serous cystadenoma, 1 case with retroperitoneal liposarcoma.Univariate analysis using pearson′s χ² test, multivariate analysis using binary Logistic regression analysis, correlation analysis using Spearman rank correlation analysis and the predictive value of pancreatic fibrosis in pancreatic fistula after pancreaticoduodenectomy was assessed using the area under the receiver operating characteristic(ROC) curve.

There were 123 cases (30.1%) with postoperative pancreatic fistula among 408 patients. Univariate analysis showed that body mass index(BMI)(P=0.005), preoperative gamma-glutamyltranspeptidase content(P=0.046), pancreatic duct diameter(P=0.001), CT value of pancreatic tissue(P=0.049), operation time(P=0.037), pancreatic stiffness (intraoperative judgment)(P=0.001) and percentage of pancreatic fibrosis(P=0.034) were the prognostic factors of pancreatic fistula. Multivariate analysis showed that BMI≥25 kg/m², pancreatic duct diameter ≤3 mm, pancreatic tissue CT value <40 Hu, pancreatic hardness (intraoperative judgments) for the soft and pancreatic lobular fibrosis percentage ≤25% of postoperative pancreatic fistula occurrence of high-risk factor(P<0.05). Pancreatic fistula′s CT value and percentage of pancreatic fibrosis were significantly lower than non-pancreatic fistula group, the difference was statistically significant(P<0.05). There were significant differences in CT value and pancreatic lobular fibrosis among different grades of pancreatic fistulae(P<0.05). Pancreatic fistula severity was negatively correlated with the CT value of pancreatic body and the percentage of fibrosis of the pancreas(P=0.005, 0.019), and there was a significant correlation between CT value of pancreatic body and the percentage of fibrosis of the pancreas(r=0.699, P=0.028). The areas under the ROC curve of percentage of pancreatic fibrosis and CT value of the pancreatic body were 0.745 and 0.714, respectively. Both of them were moderate predictive value for pancreatic fistula after pancreaticoduodenectomy.

The degree of pancreatic fibrosis is a prognostic factor for pancreatic texture and pancreatic fistula after pancreaticoduodenectomy. CT value of pancreatic body can be used as a quantitative index of pancreatic fibrosis, and predict the prognostic of pancreatic fistula after pancreaticoduodenectomy.

Pancreaticoduodenectomy; Pancreatic fistula; Fibrosis