Clinicopathologic risk factors for post-operative complications after enucleation of pancreatic neoplasms

Pancreatic enucleation is a parenchymal-sparing procedure used for highly select patients with pancreatic neoplasms. We aim to utilize a multi-institutional health research network platform (TriNetX) and a single, high-volume center to assess complications and identify risk factors associated with post-operative pancreatic fistulas (POPF) after pancreatic enucleation.

A two-tiered retrospective study was conducted. We identified 423 patients from TriNetX, and 34 patients from a single-institution IRB-approved database who underwent pancreatic enucleation between 2004-2025 and 2012-2023, respectively. Univariate and multivariate analyses were performed to determine risk factors associated with post-operative complications and occurrence of POPFs.

In the TriNetX cohort, 128 (30.3%) experienced postoperative complications after pancreatic enucleation. On univariate analysis, hyperlipidemia (HLD) (OR = 2.37), gastroesophageal reflux disease (GERD) (OR = 3.87), acute pancreatitis (OR = 8.28), chronic pancreatitis (OR = 4.76), nicotine dependence (OR = 2.36), ascites (OR = 6.49), deep vein thrombosis (DVT), pulmonary embolism (PE), and thrombophlebitis (OR = 2.95), and body mass index (BMI) ≥ 25 (OR = 1.56) were identified as significant risk factors. On multivariate analysis, acute pancreatitis (HR = 1.64), chronic pancreatitis (HR = 1.78), ascites (HR = 2.96), DVT, PE and thrombophlebitis (HR = 1.74) remained significant. In our single-institution enucleation cohort, 8 patients had a POPF (23.5%). The measured distance from the neoplasm to the main pancreatic duct (MPD) was significantly shorter in patients who developed POPF (2.8 vs 6.5 mm, P < 0.05). ROC analysis determined that shorter distance from the MPD was predictive of POPF occurrence (AUC = 0.79, p < 0.005). Increased estimated blood loss was also associated with POPF (p < 0.01).

Our study identifies clinicopathologic risk factors associated with post-operative complications and POPF after pancreatic enucleation. The distance from the neoplasm to the MPD appears to be a key component of decision-making in the development of POPF.