Predictors of post-operative pancreatic fistula formation in pancreatic neuroendocrine tumors: A national surgical quality improvement program analysis

Am J Surg. 2022 Nov;224(5):1256-1261. doi: 10.1016/j.amjsurg.2022.07.007. Epub 2022 Aug 10.

Abstract

Background: Post-operative pancreatic fistula (POPF) is a serious complication following pancreas surgery. We aimed to establish factors associated with POPF specifically in patients with pancreatic neuroendocrine tumors (PNET).

Methods: The 2014-2018 American College of Surgeons National Surgical Quality Improvement Program database was querried for patients undergoing resection for PNET. The impact of patient, tumor, and operative factors on POPF formation was evaluated.

Results: 3532 patient underwent resections for PNET. The POPF rate was significantly higher in patients with PNET (24.8%) versus non-PNET (16.4%) (p < 0.0001). Male sex (OR 1.45, 95% CI 1.11-1.89), enucleation (OR 3.14, 95% CI 1.10-8.98), pancreaticoduodenectomy (OR 1.51, 95% CI 1.13-2.03), small duct size <3 mm (OR 3.24, 95% CI 1.62-6.48), and soft gland texture (OR 1.81, 95% CI 1.18-2.77) were independently associated with POPF in PNET patients on multivariable analysis.

Conclusions: POPF is more common in patients undergoing resection for PNET and is dictated primarily by surgical approach and gland characteristics.

Keywords: NSQIP; Neuroendocrine tumor; Pancreatic surgery; Post-operative pancreatic fistula; Surgical complications.

MeSH terms

  • Humans
  • Male
  • Neuroendocrine Tumors* / pathology
  • Neuroendocrine Tumors* / surgery
  • Pancreas / surgery
  • Pancreatic Fistula / epidemiology
  • Pancreatic Fistula / etiology
  • Pancreatic Neoplasms* / pathology
  • Pancreaticoduodenectomy / adverse effects
  • Postoperative Complications / etiology
  • Quality Improvement
  • Retrospective Studies
  • Risk Factors