Pancreatic Resections: Are There Preoperative Factors Related to a “Soft Pancreas” and Are They Useful in Predicting Pancreatic Fistulas?

Abstract

Context Soft pancreatic parenchyma is the most widely recognized risk factor for pancreatic fistulas. Objective To evaluate factors related to a “soft pancreas”. Methods Retrospective study of patients who underwent pancreaticoduodenectomy or left pancreatectomy. Factors considered were: sex, age, co-morbidities, body mass index, American Society of Anesthesiologists (ASA) score, characteristics of the pancreatic remnant and preoperative diagnosis. Principal endpoints were: to recognize preoperative factors related to a soft pancreatic remnant and to establish if they are useful in predicting a pancreatic fistula. Results Two hundred and eight patients were recorded. The pancreatic fistula rate was 29.3% and it was significantly related to the type of resection, the soft texture of the pancreatic remnant (P=0.037), a Wirsung duct diameter <3 mm and the preoperative diagnosis. The risk factors predicting a soft pancreatic remnant, were BMI >24 kg/m² (P=0.011); a Wirsung duct size ≤3 (P<0.001) and patients with periampullary diseases (P<0.001). Based on these three factors, we developed a risk score model that was validated by considering the pancreatic fistula rate. We noted that the overall and clinically relevant pancreatic fistula rate significantly increased with increasing score values (P=0.002 and P=0.028, respectively). Using a score cut-off value of 6 points, patients with a score <6 were considered to be at low risk; those with a score ≥6 were considered to be at high risk. Conclusions Body mass index >24 kg/m², Wirsung duct size <3 mm and preoperative diagnosis may be considered as preoperative factors related to a soft pancreas and they resulted useful in predicting the incidence of pancreatic fistulas.