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Updated: Dec 11, 2025
Colonial Wig Pancreaticojejunostomy
Published on: March 12, 2019
Predictive Factors for Postoperative Pancreatic Fistula-A Swedish Nationwide Register-Based Study
C Williamsson1, K Stenvall2, J Wennerblom3
1Department of Clinical Sciences Lund, Surgery, Lund University and Skåne University Hospital, Getingevägen 4, 221 85, Lund, Sweden. caroline.williamsson@med.lu.se.
Insights
Postoperative pancreatic fistula (POPF) is a serious complication after pancreatoduodenectomy. High BMI, pancreaticojejunostomy, and postoperative weight gain increase POPF risk, while diabetes and biliary drainage are protective.
Area of Science:
- Gastroenterology and Hepatology
- Surgical Oncology
- Clinical Research
Background:
- Postoperative pancreatic fistula (POPF) is a significant complication following pancreatoduodenectomy (PD).
- Understanding POPF incidence and predictive factors is crucial for improving patient outcomes.
- This study utilizes a large nationwide cohort to analyze POPF in PD patients.
Purpose of the Study:
- To determine the incidence of POPF after pancreatoduodenectomy.
- To identify key predictive factors associated with the development of POPF.
- To analyze risk and protective factors using a comprehensive national dataset.
Main Methods:
- Data were extracted from the Swedish National Registry for Pancreatic and Periampullary Cancer.
- The study included all patients who underwent PD between 2010 and June 2018.
- Patients were analyzed in two groups: those with no POPF and those with clinically relevant POPF (Grade B/C).
Main Results:
- A total of 2503 patients underwent PD, with a 10% incidence of POPF (245 patients).
- POPF was associated with significantly higher overall complications and longer hospital stays.
- Risk factors for POPF included increased BMI, pancreaticojejunostomy reconstruction, and postoperative weight gain (≥2 kg).
- Protective factors against POPF were preoperative diabetes and preoperative biliary drainage.
Conclusions:
- High BMI, pancreaticojejunostomy, and early postoperative weight gain are identified as significant risk factors for POPF.
- Preoperative diabetes and biliary drainage demonstrate a protective effect against POPF development.
- These findings can inform strategies to mitigate POPF risk in pancreatoduodenectomy patients.
Background:
A serious complication after pancreatoduodenectomy (PD) is postoperative pancreatic fistula (POPF). The aim of this study was to analyse the incidence and predictive factors for POPF by using a large nationwide cohort.
Methods:
Data from the Swedish National Registry for Pancreatic and Periampullary Cancer for all patients undergoing a PD from 2010 until 30th June 2018 were collected. The material was analysed in two groups, no POPF and clinically relevant (grade B and C) POPF.
Results:
A total of 2503 patients underwent PD, of which 245 (10%) developed POPF. Patients with POPF had significantly more overall complications (Clavien Dindo ≥3a, 75% vs. 21%, p < 0.001) and longer hospital stay (median 23 [16-35] vs. 11 [8-15], p < 0.001) than patients without POPF. The risk of POPF was higher with increased BMI (OR 1.08, p < 0.001). Preoperative presence of diabetes (OR 0.52, p = 0.012) and preoperative biliary drainage (OR 0.34, p < 0.001) reduced the risk of POPF. Reconstruction with pancreaticojejunostomy caused a more than two folded increase in POPF compared with pancreaticogastrostomy (OR 2.41, p < 0.001). Weight gain ≥2 kg on postoperative day 1 was also a risk factor (OR 1.76, p < 0.001).
Conclusion:
A high BMI, a pancreaticojejunostomy and postoperative weight gain were risk factors for developing POPF. Diabetes or preoperative biliary drainage was protective.
