Shorter Pancreatic Division-To-Anastomosis Time Reduces Drain Amylase Levels After Pancreatoduodenectomy for...

Despite advances in surgical techniques, postoperative pancreatic fistula (POPF) remains a major concern after pancreatoduodenectomy (PD). Although various risk factors have been identified, most are patient-specific and nonmodifiable. This study investigated whether the time from pancreatic division to anastomosis (division-to-anastomosis time, DAT) influences postoperative outcomes.

We retrospectively analyzed 182 patients who underwent PD for nonpancreatic cancer between 2017 and 2022. The relationship between DAT and drain amylase (D-amy) levels on postoperative day 3 was evaluated. We also investigated the association between DAT and POPF development. Multiple regression analyses were performed to adjust for potential confounding factors.

Median patient age was 72 years, and 64.8% were male. Primary diagnoses included distal bile duct (35.7%), ampullary (24.7%), and duodenal (7.7%) cancers. Longer DAT was independently associated with increased D-amy levels (regression coefficient 0.16, 95% confidence interval: 0.0-0.29), with each hourly increase in DAT corresponding to a 1.45-fold increase. Grade B POPF occurred in 48% of cases. Multivariate analysis identified prolonged DAT and higher BMI as independent POPF risk factors.

Prolonged DAT during PD was associated with increased D-amy levels and POPF incidence. As a modifiable surgical factor, DAT represents a potential target for technical refinement to improve postoperative outcomes.