Risk Factors for Progression From Biochemical Leak to Clinically Relevant Postoperative Pancreatic Fistula After Pancreaticoduodenectomy. The Key of the Lock: Prognostic Nutritional Index

Abstract

Background/Aims: Postoperative pancreatic fistula (POPF), which is considered the most frightening complication after pancreatic oduodenectomy (PD), continues to be a serious problem even in experienced centers. In the present study, we aimed to determine the risk factors that increase the progression from biochemical leak (BL) to clinically relevant postoperative pancreatic fistula (CR-POPF) after PD. Materials and Methods: We retrospectively analyzed the data of 152 patients who underwent PD. A total of 71 patients who developed POPF were included in the study and divided into two groups: 52 patients remained in the BL stage and 19 patients progressed from BL to CR-POPF. The groups were compared in terms of preoperative data, perioperative findings, and postoperative results. Risk factors for progression from BL to CR-POPF were analyzed. Results: Preoperative prognostic nutritional index (PNI) was significantly lower in the CR-POPF group compared to the BL group (35.6 (30.1-47.9) vs 41.6 (33.5-58), P < .001). Receiver operating characteristic (ROC) curve analysis showed that the best cutoff of preoperative PNI value for predicting this progression was 38 (AUC = 0.835; 95% CI, 0.717-0.953; P = .001). While the progression rate was 58.3% in the group with PNI < 38, it was 10.6% with PNI >= 38. In univariate and multivariate analysis, preoperative PNI value was the only independent risk factor for progression from BL to CR-POPF after PD (OR, 15.428; 95% CI, 3.714-64.085; P < .01). Conclusion: Preoperative PNI value is an important parameter predicting the progression from BL to CR-POPF after PD.