The Role of Surgical Factors in the Development of Postpancreatoduodenectomy Acute Pancreatitis in Patients After Pancreatoduodenectomy
Year: 2025
Type: article
Study design: Observational Study
Abstract: . Introduction. Pancreatoduodenectomy (PD) is the primary surgical approach for treating malignant and select benign tumors of the pancreas and periampullary region. One of the most serious complications following PD is post-pancreatectomy acute pancreatitis (PPAP), which significantly impacts postoperative outcomes and patient prognosis. Identifying the risk factors associated with PPAP is crucial for optimizing surgical strategies, which was the primary objective of this study. Materials and methods. A retrospective analysis of 296 pancreatoduodenectomy cases was conducted, with patients categorized into two groups: those who developed PPAP (n=126) and those who did not (n=170). A comparative analysis of key intraoperative parameters was performed, along with a multivariate logistic regression analysis to determine the primary predictors of PPAP development. The analysis incorporated patient morphofunctional characteristics and technical aspects of the surgical procedure. Key factors influencing the risk of PPAP were identified. Results. Intergroup analysis demonstrated that patients with PPAP had a significantly higher body mass index (BMI) than those without PPAP (25,6 vs. 24,9, p=0,03). Among the surgical factors, the greatest impact on PPAP development was associated with the type of pancreatic anastomosis, portal vein resection, main pancreatic duct diameter, and pancreatic consistency. Specifically, pancreatogastrostomy was associated with an increased risk of PPAP (84,1% vs. 73,5%, p=0,03), while pancreatojejunostomy was associated with a lower incidence of this complication (15,9% vs. 26,5%, p=0,03). Portal vein resection significantly reduced the risk of PPAP by 2,81 times (p=0,005). A wider main pancreatic duct diameter (>3 mm) was also correlated with a lower risk (31,6% vs. 63,1%, p<0,0001). Conversely, a soft pancreatic texture markedly increased the likelihood of PPAP (79,6% vs. 38,4%, p<0,0001). The findings indicate that the choice of pancreatic remnant reconstruction technique, morphological characteristics of the pancreas, and technical aspects of the procedure substantially influence the incidence of PPAP. A soft pancreatic parenchyma was identified as the most significant predictor of this complication, while portal vein resection and a wider main pancreatic duct diameter were protective factors. These insights highlight the need to adapt surgical strategies to minimize postoperative complications following PD. Conclusions. The main risk factors for PPAP following PD include an elevated BMI (p=0,03), pancreatogastrostomy (p=0,03), a narrow main pancreatic duct diameter (p<0,0001), and a soft pancreatic texture (p<0,0001). Portal vein resection was significantly more common in patients without PPAP (p=0,004). Multivariate analysis identified three independent predictors of PPAP following PD: pancreatic texture (OR=4.40; p=0.001), main pancreatic duct diameter (OR=3.10; p=0.005), and intraoperative portal vein resection (OR=2.21; p=0.02).
Source: Kharkiv Surgical School
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W4410599292