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Hepato-pancreato-biliary

E235: Clinicopathologic Risk Factors Affecting Pancreatic Fistula Formation after Enucleation of Pancreatic Neoplasms

Introduction: Pancreatic enucleation is a parenchymal-sparing procedure for select patients that is associated with postoperative pancreatic fistulas (POPF). In this study, we explore risk factors for POPF after enucleation of pancreatic neoplasms.

Methods: This was a two-tiered study using a single-institution database and a multinational research network of over 100 healthcare organizations and 100 million patients. From the single-institution database, a cohort of patients who underwent pancreatic enucleation of a neoplasm between 1/1/2012 and 8/14/2023 were identified. Similarly, from the multinational network, patients that underwent pancreatic enucleation were identified. Patients were classified based on occurrence of POPF after enucleations. Post contrast CT and/or MRI T1/T2 weighted measurements of the distance from the neoplasm to the main pancreatic duct (MPD) were conducted. Descriptive statistics and univariate analyses were performed. P-values < 0.05 were considered significant.

Results:

In the single-institution cohort, 35 patients underwent enucleation. Of those, 8 patients (22.9%) developed POPF, while 27 patients (77.1%) did not. Patients with POPF had a mean age of 58.7 ± 11.2 years, similar to 57.0 ± 14 years in the non-POPF group. The distance of the neoplasm to the MPD was significantly greater in patients who did not develop fistulas (6.5mm ± 4.5) compared to those who did (2.8mm ± 2.6, p = 0.03). Moreover, an ROC analysis indicated that distance from the MPD to the neoplasm was highly predictive of POPF (AUC = 0.79, p = 0.002). Other factors, including tumor size, pathology, pancreatic texture, anatomic position (head, body, and tail), or intraoperative factors did not significantly correlate with POPF.

Analysis of the multinational network further identified 525 patients that underwent pancreatic enucleations. 47 patients (9.0%) developed a POPF. The median ages of patients who did and did not develop POPF were 57.6 years and 54.2 years, respectively. Among the 262 patients with recorded BMIs, there was a positive association between a BMI >25 and POPF (OR = 1.86, p = 0.03). Notably, chronic pancreatitis in this cohort (N = 112) was also associated with POPF formation. (OR = 1.88, p = 0.04).

Conclusions:

POPFs can occur frequently after pancreatic enucleation. Our study identifies clinicopathologic risk factors that correlate with POPF formation that may help surgeons determine whether an enucleation is appropriate. The distance of the neoplasm from the MPD appears to be a key component of decision-making.

Learning Objectives:

  • Upon completion, participant will be able to use distance from the main pancreatic duct to the lesion to determine whether their patients are at increased risk of POPF after enucleations.
  • Upon completion, participant will be able to assess whether an increased BMI puts patients at increased risk of post-operative complications after enucleations.
  • Upon completion, participant will be able to assess whether a history of chronic pancreatitis predisposes a patient to increased risk of POPF formation after enucleations.