Arguments for an individualized closure of the pancreatic remnant after distal pancreatic resection

AIM:To analyze risk factors for postoperative pancreatic fistula(POPF) rate after distal pancreatic resection(DPR).METHODS:We performed a retrospective analysis of 126 DPRs during 16 years.The primary endpoint was clinically relevant pancreatic fistula.RESULTS:Over the years,there was an increasing rate of operations in patients with a high-risk pancreas and a significant change in operative techniques.POPF was the most prominent factor for perioperative morbidity.Significant risk factors for pancreatic fistula were high body mass index(BMI) [odds ratio(OR) = 1.2(CI:1.1-1.3),P = 0.001],high-risk pancreatic pathology [OR = 3.0(CI:1.3-7.0),P = 0.011] and direct closure of the pancreas by hand suture [OR = 2.9(CI:1.2-6.7),P = 0.014].Of these,BMI and hand suture closure were independent risk factors in multivariate analysis.While hand suture closure was a risk factor in the low-risk pancreas subgroup,high BMI further increased the fistula rate for a high-risk pancreas.CONCLUSION:We propose a risk-adapted and indication-adapted choice of the closure method for the pancreatic remnant to reduce pancreatic fistula rate.