Pancreatic steatosis and post-operative pancreatic fistula after pancreatectomy.

BACKGROUND & AIMS: Pancreatic steatosis (PS), the accumulation of fat in the pancreas, has been associated with multiple diseases. Its role in the development of post-operative pancreatic fistula (POPF) remains unclear. We aimed to describe the association between PS and POPF.

METHODS

We performed a single-center retrospective study of adult patients undergoing pancreatectomy, excluding total pancreatectomy. The primary endpoint was a grade B or C POPF within six months. PS was measured histologically and radiologically through the pancreatic-to-spleen attenuation ratio (P/S) and pancreas minus spleen attenuation difference (P-S). Multivariable logistic regression analysis was used to derive a risk model to predict POPF.

RESULTS

Of 1283 patients included, 144 (11.2%) developed POPF. Histologic and radiologic PS were not associated with the development of POPF. A higher BMI, longer operative time, small pancreatic duct, soft pancreas, and type of surgery were strongly associated with POPF, p≤0.001. A four-variable model with the best discrimination was derived (AUC 0.647, 95% CI: 0.588-0.707). The variables included were history of chronic pancreatitis (OR 2.57, p=0.004), history of bowel resection (OR 1.94, p=0.004), BMI (OR 1.05 per 1 kg/m2, p=0.004), and distal pancreatectomy (OR 0.54, p=0.006). At the lowest sextile of the risk score, the observed rate of POPF was 3.8%, whereas at the highest sextile, it was 19.0% (risk ratio: 5.03, p<0.001).

CONCLUSION

Although a higher BMI was strongly associated with POPF, PS was not. We derived a four-variable risk score to predict POPF. Further external validation is advised.