Risk factor analysis of postoperative pancreatic fistula after distal pancreatectomy with a focus on the peritoneum to portal vein distance on computed tomography.

Background: Postoperative pancreatic fistula (POPF) is a major complication of distal pancreatectomy (DP). Although the visceral fat area (VFA) is a risk factor for POPF in DP, its measurement is complicated. This study aimed to identify a simple marker as a predictive indicator of POPF.

Methods: We included 210 patients who underwent resection at our institution between 2020 and 2023. The patients' characteristics, preoperative laboratory data, and radiographic findings (e.g., portal vein distance and VFA) and their association with pancreatic fistula after DP were analyzed. POPF was defined as Grade B or C pancreatic fistula on the basis of the International Study Group of Pancreatic Surgery 2016 consensus.

Results: POPF developed in 82 (39.0%) patients. Univariate analysis showed that female sex, pancreatic thickness of the cutting line, operative time, blood loss, C-reactive protein (CRP) level on postoperative day (POD) 3, drain amylase level on POD 3, VFA, and the peritoneum to portal vein distance (PPD) were associated with POPF. Receiver operating characteristic curve analysis of PPD showed a higher area under the curve than VFA (cutoff for PPD: 68 mm). Multivariate analysis showed that CRP (odds ratio [OR]: 2.214), drain amylase (OR: 2.875), and PPD (OR: 15.538) were independent risk factors. When we compared the DP fistula risk score and PPD, receiver operating characteristic analysis showed areas under the curve of 0.650 and 0.803, respectively.

Conclusions: A PPD of ≥68 mm is a useful risk predictor of POPF. Determining this distance is simple and easily applicable in the clinical setting.