Multivariate analysis of influencing factor of pancreatic fistula after distal pancreatectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

KONG Xianghu ¹ ,  HAN Wei ¹ , LI Qiuying ²

1. Department of Pancreas Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830000, P. R. China;
2. Department of Geriatrics, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi 830000, P. R. China;

Corresponding author：

HAN Wei, Email: 13999846637@139.com

Keywords：

distal pancreatectomy; postoperative pancreatic fistula; neutrophil/lymphocyte ratio; prognostic nutrition index

DOI：

10.7507/1007-9424.201908094

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Objective To investigate the factors that affect the occurrence of postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP).Methods The clinical data of 114 patients underwent DP who were performed in the First Affiliated Hospital of Xinjiang Medical University from Jan. 2014 to Jun. 2019, were retrospectively analyzed.Results In this group of 114 patients, 43 cases (37.7%) of POPF occurred after DP, including 19 cases of grade A (biochemical fistula), 21 cases of grade B, and 3 cases of grade C. The univariate analysis results showed that: BMI value, drinking history, preoperative plasma albumin level, postoperative plasma albumin level, postoperative neutrophil/lymphocyte ratio (NLR), preoperative and postoperative prognostic nutrition index (PNI) levels were significant different between the POPF group and non-POPF group (P<0.05). Multivariate analysis results showed that: preoperative plasma albumin>35 g/L [OR=0.115, 95%CI was (0.038, 0.348)], postoperative plasma albumin>35 g/L [OR=0.126, 95%CI was (0.031, 0.516)], and postoperative NLR value≤6.65 [OR=0.149, 95%CI was (0.048, 0.461)] were the influencing factors of POPF after DP. The area under curve of postoperative NLR was 0.731 [95%CI was (0.639, 0.824)]. Conclusion Preoperative and postoperative plasma albumin>35 g/L, as well as postoperative NLR ≤6.65 are protective factors for POPF after DP, and postoperative NLR can be used as a predictor of POPF.

Citation： KONG Xianghu, HAN Wei, LI Qiuying. Multivariate analysis of influencing factor of pancreatic fistula after distal pancreatectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(6): 708-713. doi: 10.7507/1007-9424.201908094 Copy

1.	吴孟超, 吴在德. 黄家驷外科学. 第 7 版. 北京: 人民卫生出版社, 2008: 1846-1847.
2.	Yoshioka R, Saiura A, Koga R, et al. Risk factors for clinical pancreatic fistula after distal pancreatectomy: analysis of consecutive 100 patients. World J Surg, 2010, 34(1): 121-125.
3.	Sierzega M, Niekowal B, Kulig J, et al. Nutritional status affects the rate of pancreatic fistula after distal pancreatectomy: a multivariate analysis of 132 patients. J Am Coll Surg, 2007, 205(1): 52-59.
4.	Goh BK, Tan YM, Chung YF, et al. Critical appraisal of 232 consecutive distal pancreatectomies with emphasis on risk factors, outcome, and management of the postoperative pancreatic fistula: a 21-year experience at a single institution. Arch Surg, 2008, 143(10): 956-965.
5.	Seeliger H, Christians S, Angele MK, et al. Risk factors for surgical complications in distal pancreatectomy. Am J Surg, 2010, 200(3): 311-317.
6.	Soga K, Ochiai T, Sonoyama T, et al. Risk factors for postoperative pancreatic fistula in distal pancreatectomy. Hepatogastroenterology, 2011, 58(109): 1372-1376.
7.	Subhedar PD, Patel SH, Kneuertz PJ, et al. Risk factors for pancreatic fistula after stapled gland transection. Am Surg, 2011, 77(8): 965-970.
8.	Okano K, Kakinoki K, Suto H, et al. Slow parenchymal flattening technique for distal pancreatectomy using an endopath stapler: simple and safe technical management. Hepatogastroenterology, 2010, 57(102-103): 1309-1313.
9.	Nakamura M, Ueda J, Kohno H, et al. Prolonged peri-firing compression with a linear stapler prevents pancreatic fistula in laparoscopic distal pancreatectomy. Surg Endosc, 2011, 25(3): 867-871.
10.	Sepesi B, Moalem J, Galka E, et al. The influence of staple size on fistula formation following distal pancreatectomy. J Gastrointest Surg, 2012, 16(2): 267-274.
11.	Bassi C, Marchegiani G, Dervenis C, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery, 2017, 161(3): 584-591.
12.	Sugimoto M, Takahashi S, Kojima M, et al. In patients with a soft pancreas, a thick parenchyma, a small duct, and fatty infiltration are significant risks for pancreatic fistula after pancreaticoduo- denectomy. J Gastrointest Surg, 2017, 21(5): 846-854.
13.	Chang YR, Kang JS, Jang JY, et al. Prediction of pancreatic fistula after distal pancreatectomy based on cross-sectional images. World J Surg, 2017, 41(6): 1610-1617.
14.	Hubbard TJ, Lawson-McLean A, Fearon KC. Nutritional predictors of postoperative outcome in pancreatic cancer (Br J Surg 2011; 98: 268-274). Br J Surg, 2011, 98(7): 1032.
15.	Molinari E, Bassi C, Salvia R, et al. Amylase value in drains after pancreatic resection as predictive factor of postoperative pancreatic fistula: results of a prospective study in 137 patients. Ann Surg, 2007, 246(2): 281-287.
16.	Daniel F, Tamim H, Hosni M, et al. Validation of day 1 drain fluid amylase level for prediction of clinically relevant fistula after distal pancreatectomy using the NSQIP database. Surgery, 2019, 165(2): 315-322.
17.	Ansorge C, Nordin JZ, Lundell L, et al. Diagnostic value of abdominal drainage in individual risk assessment of pancreatic fistula following pancreaticoduodenectomy. Br J Surg, 2014, 101(2): 100-108.
18.	Hiyoshi M, Chijiiwa K, Fujii Y, et al. Usefulness of drain amylase, serum C-reactive protein levels and body temperature to predict postoperative pancreatic fistula after pancreaticoduodenectomy. World J Surg, 2013, 37(10): 2436-2442.
19.	Kosaka H, Kuroda N, Suzumura K, et al. Multivariate logistic regression analysis for prediction of clinically relevant pancreatic fistula in the early phase after pancreaticoduodenectomy. J Hepatobiliary Pancreat Sci, 2014, 21(2): 128-133.
20.	Uemura K, Murakami Y, Sudo T, et al. Indicators for proper management of surgical drains following pancreaticoduodenectomy. J Surg Oncol, 2014, 109(7): 702-707.
21.	Kawai M, Tani M, Hirono S, et al. How do we predict the clinically relevant pancreatic fistula after pancreaticoduodenectomy?—an analysis in 244 consecutive patients. World J Surg, 2009, 33(12): 2670-2678.
22.	Chen W, Yang J, Li B, et al. Neutrophil to lymphocyte ratio as a novel predictor of outcome in patients with severe traumatic brain injury. J Head Trauma Rehabil, 2018, 33(1): E53-E59.
23.	Guasti L, Dentali F, Castiglioni L, et al. Neutrophils and clinical outcomes in patients with acute coronary syndromes and/or cardiac revascularisation. A systematic review on more than 34,000 subjects. Thromb Haemost, 2011, 106(4): 591-599.
24.	Ertem AG, Ozcelik F, Kasapkara HA, et al. Neutrophil lymphocyte ratio as a predictor of left ventricular apical thrombus in patients with myocardial infarction. Korean Circ J, 2016, 46(6): 768-773.
25.	Bhat T, Teli S, Rijal J, et al. Neutrophil to lymphocyte ratio and cardiovascular diseases: a review. Expert Rev Cardiovasc Ther, 2013, 11(1): 55-59.
26.	Papa A, Emdin M, Passino C, et al. Predictive value of elevated neutrophil-lymphocyte ratio on cardiac mortality in patients with stable coronary artery disease. Clin Chim Acta, 2008, 395(1-2): 27-31.
27.	Nagakawa Y, Matsudo T, Hijikata Y, et al. Bacterial contamination in ascitic fluid is associated with the development of clinically relevant pancreatic fistula after pancreatoduodenectomy. Pancreas, 2013, 42(4): 701-706.
28.	Ikeguchi M, Ashida K. Prognostic significance of C-reactive protein/albumin ratio in patients with locally advanced unresectable colorectal cancer. Indian J Surg Oncol, 2017, 8(3): 263-266.

1. 吴孟超, 吴在德. 黄家驷外科学. 第 7 版. 北京: 人民卫生出版社, 2008: 1846-1847.
2. Yoshioka R, Saiura A, Koga R, et al. Risk factors for clinical pancreatic fistula after distal pancreatectomy: analysis of consecutive 100 patients. World J Surg, 2010, 34(1): 121-125.
3. Sierzega M, Niekowal B, Kulig J, et al. Nutritional status affects the rate of pancreatic fistula after distal pancreatectomy: a multivariate analysis of 132 patients. J Am Coll Surg, 2007, 205(1): 52-59.
4. Goh BK, Tan YM, Chung YF, et al. Critical appraisal of 232 consecutive distal pancreatectomies with emphasis on risk factors, outcome, and management of the postoperative pancreatic fistula: a 21-year experience at a single institution. Arch Surg, 2008, 143(10): 956-965.
5. Seeliger H, Christians S, Angele MK, et al. Risk factors for surgical complications in distal pancreatectomy. Am J Surg, 2010, 200(3): 311-317.
6. Soga K, Ochiai T, Sonoyama T, et al. Risk factors for postoperative pancreatic fistula in distal pancreatectomy. Hepatogastroenterology, 2011, 58(109): 1372-1376.
7. Subhedar PD, Patel SH, Kneuertz PJ, et al. Risk factors for pancreatic fistula after stapled gland transection. Am Surg, 2011, 77(8): 965-970.
8. Okano K, Kakinoki K, Suto H, et al. Slow parenchymal flattening technique for distal pancreatectomy using an endopath stapler: simple and safe technical management. Hepatogastroenterology, 2010, 57(102-103): 1309-1313.
9. Nakamura M, Ueda J, Kohno H, et al. Prolonged peri-firing compression with a linear stapler prevents pancreatic fistula in laparoscopic distal pancreatectomy. Surg Endosc, 2011, 25(3): 867-871.
10. Sepesi B, Moalem J, Galka E, et al. The influence of staple size on fistula formation following distal pancreatectomy. J Gastrointest Surg, 2012, 16(2): 267-274.
11. Bassi C, Marchegiani G, Dervenis C, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery, 2017, 161(3): 584-591.
12. Sugimoto M, Takahashi S, Kojima M, et al. In patients with a soft pancreas, a thick parenchyma, a small duct, and fatty infiltration are significant risks for pancreatic fistula after pancreaticoduo- denectomy. J Gastrointest Surg, 2017, 21(5): 846-854.
13. Chang YR, Kang JS, Jang JY, et al. Prediction of pancreatic fistula after distal pancreatectomy based on cross-sectional images. World J Surg, 2017, 41(6): 1610-1617.
14. Hubbard TJ, Lawson-McLean A, Fearon KC. Nutritional predictors of postoperative outcome in pancreatic cancer (Br J Surg 2011; 98: 268-274). Br J Surg, 2011, 98(7): 1032.
15. Molinari E, Bassi C, Salvia R, et al. Amylase value in drains after pancreatic resection as predictive factor of postoperative pancreatic fistula: results of a prospective study in 137 patients. Ann Surg, 2007, 246(2): 281-287.
16. Daniel F, Tamim H, Hosni M, et al. Validation of day 1 drain fluid amylase level for prediction of clinically relevant fistula after distal pancreatectomy using the NSQIP database. Surgery, 2019, 165(2): 315-322.
17. Ansorge C, Nordin JZ, Lundell L, et al. Diagnostic value of abdominal drainage in individual risk assessment of pancreatic fistula following pancreaticoduodenectomy. Br J Surg, 2014, 101(2): 100-108.
18. Hiyoshi M, Chijiiwa K, Fujii Y, et al. Usefulness of drain amylase, serum C-reactive protein levels and body temperature to predict postoperative pancreatic fistula after pancreaticoduodenectomy. World J Surg, 2013, 37(10): 2436-2442.
19. Kosaka H, Kuroda N, Suzumura K, et al. Multivariate logistic regression analysis for prediction of clinically relevant pancreatic fistula in the early phase after pancreaticoduodenectomy. J Hepatobiliary Pancreat Sci, 2014, 21(2): 128-133.
20. Uemura K, Murakami Y, Sudo T, et al. Indicators for proper management of surgical drains following pancreaticoduodenectomy. J Surg Oncol, 2014, 109(7): 702-707.
21. Kawai M, Tani M, Hirono S, et al. How do we predict the clinically relevant pancreatic fistula after pancreaticoduodenectomy?—an analysis in 244 consecutive patients. World J Surg, 2009, 33(12): 2670-2678.
22. Chen W, Yang J, Li B, et al. Neutrophil to lymphocyte ratio as a novel predictor of outcome in patients with severe traumatic brain injury. J Head Trauma Rehabil, 2018, 33(1): E53-E59.
23. Guasti L, Dentali F, Castiglioni L, et al. Neutrophils and clinical outcomes in patients with acute coronary syndromes and/or cardiac revascularisation. A systematic review on more than 34,000 subjects. Thromb Haemost, 2011, 106(4): 591-599.
24. Ertem AG, Ozcelik F, Kasapkara HA, et al. Neutrophil lymphocyte ratio as a predictor of left ventricular apical thrombus in patients with myocardial infarction. Korean Circ J, 2016, 46(6): 768-773.
25. Bhat T, Teli S, Rijal J, et al. Neutrophil to lymphocyte ratio and cardiovascular diseases: a review. Expert Rev Cardiovasc Ther, 2013, 11(1): 55-59.
26. Papa A, Emdin M, Passino C, et al. Predictive value of elevated neutrophil-lymphocyte ratio on cardiac mortality in patients with stable coronary artery disease. Clin Chim Acta, 2008, 395(1-2): 27-31.
27. Nagakawa Y, Matsudo T, Hijikata Y, et al. Bacterial contamination in ascitic fluid is associated with the development of clinically relevant pancreatic fistula after pancreatoduodenectomy. Pancreas, 2013, 42(4): 701-706.
28. Ikeguchi M, Ashida K. Prognostic significance of C-reactive protein/albumin ratio in patients with locally advanced unresectable colorectal cancer. Indian J Surg Oncol, 2017, 8(3): 263-266.

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Multivariate analysis of influencing factor of pancreatic fistula after distal pancreatectomy

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