Assessment of preoperative risk factors for complications after distal pancreatectomy for neuroendocrine tumors

Abstract

INTRODUCTION: Resection of pancreatic neuroendocrine tumors is associated with a high risk of clinically relevant postoperative complications.
This study aimed to evaluate and analyze the relationship between selected preoperative risk factors and the occurrence of clinically relevant early postoperative complications, including pancreatic fistulas, after distal pancreatic resections for neuroendocrine tumors.
MATERIAL AND METHODS: The analysis included 78 patients who underwent surgery for neuroendocrine tumors of the body or tail of the pancreas. A retrospective analysis was carried out regarding age, sex, comorbidities, preoperative C-reactive protein (CRP) levels, American Society of Anesthesiologists (ASA) score, tumor size, and Wirsung’s duct diameter as measured on preoperative computed tomography (CT) scans of the abdomen. The severity of postoperative complications was assessed using the Clavien-Dindo classification, while the International Study Group on Pancreatic Fistula (ISGPF) classification was utilized to evaluate pancreatic fistulas.
RESULTS: Pancreatic fistula was the most common complication and occurred in 42 cases (55.3%). A significant relationship was found between the ASA score and complication severity according to the Clavien-Dindo classification (p = 0.01). Multivariate analyses indicated associations between the occurrence of pancreatic fistula and male sex (OR = 0.17, p = 0.06), age (OR = 0.86, p < 0.01), preoperative CRP level (OR = 1.05, p = 0.01), and ASA score (OR = 125.97, p < 0.01). No significant correlation was identified between tumor size or Wirsung’s duct diameter and the occurrence of clinically relevant postoperative complications or pancreatic fistulas (p > 0.05).
CONCLUSION: The ASA score correlates with the severity of postoperative complications as assessed by the Clavien-Dindo classification. The risk factors for developing B and/or C pancreatic fistulas include age, male sex, elevated preoperative CRP levels, and higher ASA scores.