Distal pancreatectomy for chronic pancreatitis: The influence of body mass index.

Abstract

A relatively small number of patients with chronic pancreatitis have disease localized to the pancreatic tail. These patients benefit from distal pancreatectomy; however, disease-related inflammation and vascular involvement complicate surgery. Few large studies have analyzed distal pancreatectomy outcomes in chronic pancreatitis. We hypothesized that patient and disease-related features may predict outcomes of distal pancreatectomy for chronic pancreatitis. Patients with chronic pancreatitis undergoing distal pancreatectomy from 2007 to 2022 were analyzed. Operative data, patient comorbidities, and perioperative outcomes were captured via institutional National Surgical Quality Improvement Program protocol. Descriptive statistics, univariate, and multivariable analyses were performed to evaluate factors associated with outcome, including clinically relevant postoperative pancreatic fistula. Among 186 patients analyzed, 41% were female with mean age of 50.1 (±12.7) years. Most operations (149, 80%) were performed open, and surgical drains were used in 85%. Median length of stay was 6 (interquartile range, 4) days. The 30-day readmission rate was 12%. Morbidity occurred in 41%. Postoperative pancreatic fistula was seen in 60 (43%); 34 (18%) had biochemical leaks, 25 (13%) had grade B, and 1 patient had grade C postoperative pancreatic fistula. No postoperative mortality occurred. On multivariable analysis, organ space infection (P = .002) and increased body mass index (body mass index, P = .018) were significantly associated with clinically relevant postoperative pancreatic fistula. Patients with body mass index <25.5 kg/m² had clinically relevant postoperative pancreatic fistula of 6.4%, whereas those with body mass index >25.4 had clinically relevant postoperative pancreatic fistula of 19.4% (P = .047). Distal pancreatectomy may be performed safely in select patients with chronic pancreatitis. Increased body mass index predicts clinically relevant postoperative pancreatic fistula, highlighting patients in whom fistula mitigation strategy should be used.