Risk Factors for Clinical Pancreatic Fistula After Distal Pancreatectomy: Analysis of Consecutive 100 Patients

The mortality associated with distal pancreatectomy (DP) has declined to < 5% in recent years in high-volume centers. However, morbidity remains high, ranging from 32% to 57%. Pancreatic fistula (PF) is the most common complication after DP. The aim of this study was to analyze factors associated with the occurrence of clinical PF. A retrospective review was performed of the medical records of 100 patients who underwent DP in our institution between May 2001 and January 2009. There was no mortality, but morbidity was occurred in 65 patients (65%), with major complications occurring in 9 patients (9%). PF occurred in 50 patients (50%) and clinical PF occurred in 23 patients (23%). Multivariate analysis indicated that independent risk factors for clinical PF were: age younger than 65 years (P = 0.049; odds ratio (OR) 2.958; 95% confidence interval (CI) 1.007-8.688), not ligating the main pancreatic duct (MPD) (P = 0.02; OR 4.933; 95% CI 1.283-18.967), and extended lymphadenectomy (P = 0.008; OR 4.773; 95% CI 1.504-15.145). Age < 65 years, not ligating the MPD, and extended lymphadenectomy are independent risk factors for clinical PF.