Excess weight adversely influences treatment length of postoperative pancreatic fistula: A retrospective study of 900 patients

Objectives Pancreatectomy is still associated with a high morbidity rate, even in high-volume centers, and a leading cause of morbidity is represented by postoperative pancreatic fistula (POPF). Many previous studies have evaluated the risk factors for the occurrence of POPF, but protracted courses of POPF have not been fully discussed. Methods This study included 900 patients who underwent pancreatectomy between January 1991 and June 2013 after exclusion of patients who underwent total pancreatectomy. Subgroup analysis of the duration of drain placement was conducted among patients with POPF to identify predictive factors for a protracted course of POPF. Results Overall, 292 patients (32.4%) had clinically relevant POPF (grade B/C). The length of drain placement in patients with a body mass index (BMI) of 25 kg/m² or greater was significantly longer than that in patients with a BMI of less than 25 kg/m² (44.8 ± 25.2 vs 33.8 ± 21.2 days, respectively; P = 0.001). The operative procedure, duct diameter, and pancreatic texture, which were independent risk factors for clinically relevant POPF, did not delay removal of the drainage tubes. Conclusions A BMI of 25 kg/m² or greater was the only factor associated with delayed POPF healing. Vigilant postoperative management after pancreatectomy should be considered in obese patients.