INTRODUCTION Postoperative pancreatic fistula (POPF) is common after distal pancreatectomy (DP). Whilst extensive investigation on potential predictors has been carried out, there is little evidence regarding POPF healing time. METHODS This is a retrospective analysis of all consecutive DPs performed at the Department of General and Pancreatic Surgery, University of Verona Hospital Trust, from 2015 to 2019. Perioperative variables were analyzed identifying possible predictors of POPF healing time defined as days between surgery and last drain removal due to POPF. RESULTS A total of 496 patients were included. POPF rate was 28.2% and median POPF healing time was 30 days (CI95% 28 - 31). Independent predictors of POPF were BMI (OR 1.073, CI95% 1.010-1.147, p= 0.040), operative time (OR CI95% 1.002 - 1.009, p= 0.003) and post-operative acute pancreatitis (OR 3.793, CI95%,1.852 - 7.767, p< 0.001). Independent predictors of POPF healing time were female sex (HR 1.323, CI95% 1.093 - 1.998, p= 0.042), preoperative pancreatic enzymes replacement therapy (HR 2.319, CI95% 1.195 - 4.498, p= 0.013), ASA score 3 (HR 0.278, CI95% 0.119 - 0.646, p= 0.003), pancreatic transection with ultrasonic dissector (HR 0.605, CI95% 0.404 - 0.907, p= 0.015) and positive drain cultures (HR 0.635, CI95% 0.443 - 0.910, p= 0.013). CONCLUSION POPF healing after DP is a slow process since only half of patients recover within 30 days of surgery. A longer healing time can be predicted early in the postoperative period with significant implications in therapeutic choices.
Predictors of pancreatic fistula healing time after distal pancreatectomy.