Purpose

In this study, it was aimed to determine the predictors of clinically relevant postoperative pancreatic fistula (CR-POPF) following pancreaticoduodenectomy (PD) and clinical significance of mean platelet volume (MPV)/total platelet count ratio (MPR) as a new predictor for CR-POPF.

Methods

A total of 105 patients who underwent PD consecutively due to periampullary located diseases were included in the study. Patients were divided into two groups as CR-POPF and no postoperative pancreatic fistula (No-POPF). Demographic parameters, preoperative serum-based inflammatory indicators, surgical procedures, intraoperative findings, and histopathological parameters were recorded retrospectively from prospectively recorded patient files and compared between the groups.

Results

CR-POPF occurred in 16 (15.2%) patients: 8 (7.6%) were grade B and 8 (7.6%) were grade C according to the ISGPF classification. In univariate analysis, intraoperative blood loss > 580 mL (OR: 5.25, p = 0.001), intraoperative blood transfusion (OR: 5.96, p = 0.002), intraoperative vasoconstrictor medication (OR: 4.17, p = 0.014), benign histopathology (OR: 3.51, p = 0.036), and poor differentiation in malignant tumors (OR: 4.07, p = 0.044) were significantly higher in the CR-POPF group, but not significant in multivariate analysis. Soft pancreatic consistency (OR: 6.08, p = 0.013), pancreatic duct diameter < 2.5 mm (OR: 17.15, p < 0.001), and MPR < 28.9 (OR: 13.91, p < 0.001) were the independent predictors of CR-POPF according to multivariate analysis. Neoadjuvant treatment history and simultaneous vascular resection were less likely to cause CR-POPF development; however, they were insignificant.

Conclusion

Soft pancreatic consistency, pancreatic duct diameter, and preoperative MPR were the independent predictors of CR-POPF following PD. Decreased MPR is a strong predictor for CR-POPF and should be considered when deciding treatment strategies.

中文翻译：

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胰十二指肠切除术后胰瘘 (POPF) 的预测因子：平均血小板体积 (MPV)/血小板计数比作为新预测因子的临床意义

目的

本研究旨在确定胰十二指肠切除术 (PD) 后临床相关术后胰瘘 (CR-POPF) 的预测因子，以及平均血小板体积 (MPV)/总血小板计数比 (MPR) 作为新预测因子的临床意义。 CR-POPF。

方法

共有 105 名因壶腹周围疾病连续接受 PD 的患者被纳入研究。患者分为CR-POPF组和术后无胰瘘（No-POPF）两组。从前瞻性记录的患者档案中回顾性记录人口统计学参数、术前基于血清的炎症指标、手术程序、术中发现和组织病理学参数，并在组间进行比较。

结果

CR-POPF 发生在 16 名 (15.2%) 患者中：根据 ISGPF 分类，8 名 (7.6%) 为 B 级，8 名 (7.6%) 为 C 级。在单因素分析中，术中失血 > 580 mL（OR：5.25，p  = 0.001），术中输血（OR：5.96，p  = 0.002），术中血管收缩药物（OR：4.17，p  = 0.014），良性组织病理学（OR : 3.51, p  = 0.036) 和恶性肿瘤分化差 (OR: 4.07, p  = 0.044) 在 CR-POPF 组中显着升高，但在多变量分析中不显着。软胰腺稠度（OR：6.08，p  = 0.013），胰管直径 < 2.5 mm（OR：17.15，p < 0.001) 和 MPR < 28.9 (OR: 13.91, p  < 0.001) 根据多变量分析是 CR-POPF 的独立预测因子。新辅助治疗史和同时血管切除不太可能导致 CR-POPF 发展；但是，它们微不足道。

结论

软胰腺稠度、胰管直径和术前 MPR 是 PD 后 CR-POPF 的独立预测因素。MPR 降低是 CR-POPF 的强预测因子，在决定治疗策略时应予以考虑。