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Risk Factors For Progression From Biochemical Leak to Clinically Relevant Postoperative Pancreatic Fistula After

Mehmet Can Aydin1, Oguzhan Ozsay2, Kagan Karabulut2

  • 1Department of Gastrointestinal Surgery, Bursa State Hospital, Bursa, Türkiye.

The Turkish Journal of Gastroenterology : the Official Journal of Turkish Society of Gastroenterology
|December 5, 2024
PubMed

Insights

Low preoperative prognostic nutritional index (PNI) is a key risk factor for progression from biochemical leak to clinically relevant postoperative pancreatic fistula (CR-POPF) after pancreaticoduodenectomy (PD). Identifying patients with PNI < 38 can help predict and manage this serious complication.

Area of Science:

  • Gastroenterology and Hepatology
  • Surgical Oncology
  • Surgical Complications

Background:

  • Postoperative pancreatic fistula (POPF) is a significant complication following pancreaticoduodenectomy (PD).
  • Progression from biochemical leak (BL) to clinically relevant POPF (CR-POPF) remains a challenge.
  • Identifying predictive factors for CR-POPF is crucial for patient management.

Purpose of the Study:

  • To determine risk factors for progression from BL to CR-POPF after PD.
  • To evaluate the predictive value of preoperative prognostic nutritional index (PNI) for this progression.

Main Methods:

  • Retrospective analysis of 152 patients undergoing PD.
  • Comparison of 52 patients with BL versus 19 patients who progressed to CR-POPF.
  • Analysis of preoperative, perioperative, and postoperative data.

Main Results:

  • Preoperative PNI was significantly lower in the CR-POPF group (35.6 vs 41.6, P < .001).
  • A PNI cutoff of 38 predicted progression with high accuracy (AUC = 0.835).
  • Progression rates were 58.3% for PNI < 38 and 10.6% for PNI ≥ 38.
  • Low preoperative PNI was the sole independent risk factor for BL to CR-POPF progression (OR, 15.428; P < .01).

Conclusions:

  • Preoperative PNI is a critical predictor of CR-POPF development after PD.
  • Patients with a PNI < 38 are at significantly higher risk.
  • Incorporating PNI assessment may improve risk stratification and management strategies for POPF.
Abstract

Keywords:
Prognostic nutritional indexbiochemical leakpostoperative pancreatic fistula

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