{"title":"Predictive factors of postoperative ascites after laparoscopic pancreaticoduodenectomy for periampullary carcinoma.","authors":"Chuan-Zhi Tang, Zhong-Jun Wu, Da-Di Peng","doi":"10.1016/j.hbpd.2025.08.002","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic pancreaticoduodenectomy (LPD) has gained growing acceptance for the resection of periampullary carcinoma. However, postoperative ascites (POA) frequently occurs after LPD, yet little is known about the underlying factors that promote POA under this laparoscopic approach. This study aimed to explore the clinical influence of POA after LPD and its potential predictors.</p><p><strong>Methods: </strong>Patients diagnosed with periampullary carcinoma who subsequently underwent LPD from December 2015 to February 2023 were reviewed. Patients were assigned to the two groups by whether daily abdominal drainage > 500 mL for at least three consecutive days, followed by subgroup analysis of pancreatic fistula (PF)-POA and non-PF-POA. Variables, including preoperative laboratory tests, past history, surgery-related factors, and incidence of complications, were compared. In addition, logistic regression analysis was applied to reveal the potential independent risk factors for PF-POA and non-PF-POA.</p><p><strong>Results: </strong>A total of 38 patients (17.4 %) developed POA, with 17 having PF-POA and 21 having non-PF-POA. Patients with grade B PF-POA experienced a higher incidence of intra-abdominal infection, and a longer hospital stay compared with other groups. Multivariate analysis demonstrated that prothrombin time > 14 s and main pancreatic duct diameter < 3 mm were independent risk factors for PF-POA. Moreover, male sex, total bilirubin > 34.2 μmol/L and platelet count < 100 × 10<sup>9</sup>/L were independent risk factors for non-PF-POA. The areas under the receiver operating characteristic curve were 0.682 and 0.786 for predicting PF-POA and non-PF-POA, respectively.</p><p><strong>Conclusions: </strong>LPD recovery and postoperative complications are impacted by POA, where PF-POA is the most clinically relevant POA. Prolonged prothrombin time and narrowed main pancreatic duct were independent risk factors for PF-POA; male sex, elevated total bilirubin level, and decreased platelet count were independent risk factors for non-PF-POA.</p>","PeriodicalId":55059,"journal":{"name":"Hepatobiliary & Pancreatic Diseases International","volume":" ","pages":""},"PeriodicalIF":4.4000,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Hepatobiliary & Pancreatic Diseases International","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.hbpd.2025.08.002","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Laparoscopic pancreaticoduodenectomy (LPD) has gained growing acceptance for the resection of periampullary carcinoma. However, postoperative ascites (POA) frequently occurs after LPD, yet little is known about the underlying factors that promote POA under this laparoscopic approach. This study aimed to explore the clinical influence of POA after LPD and its potential predictors.
Methods: Patients diagnosed with periampullary carcinoma who subsequently underwent LPD from December 2015 to February 2023 were reviewed. Patients were assigned to the two groups by whether daily abdominal drainage > 500 mL for at least three consecutive days, followed by subgroup analysis of pancreatic fistula (PF)-POA and non-PF-POA. Variables, including preoperative laboratory tests, past history, surgery-related factors, and incidence of complications, were compared. In addition, logistic regression analysis was applied to reveal the potential independent risk factors for PF-POA and non-PF-POA.
Results: A total of 38 patients (17.4 %) developed POA, with 17 having PF-POA and 21 having non-PF-POA. Patients with grade B PF-POA experienced a higher incidence of intra-abdominal infection, and a longer hospital stay compared with other groups. Multivariate analysis demonstrated that prothrombin time > 14 s and main pancreatic duct diameter < 3 mm were independent risk factors for PF-POA. Moreover, male sex, total bilirubin > 34.2 μmol/L and platelet count < 100 × 109/L were independent risk factors for non-PF-POA. The areas under the receiver operating characteristic curve were 0.682 and 0.786 for predicting PF-POA and non-PF-POA, respectively.
Conclusions: LPD recovery and postoperative complications are impacted by POA, where PF-POA is the most clinically relevant POA. Prolonged prothrombin time and narrowed main pancreatic duct were independent risk factors for PF-POA; male sex, elevated total bilirubin level, and decreased platelet count were independent risk factors for non-PF-POA.
期刊介绍：
Hepatobiliary & Pancreatic Diseases International (HBPD INT) (ISSN 1499-3872 / CN 33-1391/R) a bimonthly journal published by First Affiliated Hospital, Zhejiang University School of Medicine, China. It publishes peer-reviewed original papers, reviews and editorials concerned with clinical practice and research in the fields of hepatobiliary and pancreatic diseases. Papers cover the medical, surgical, radiological, pathological, biochemical, physiological and historical aspects of the subject areas under the headings Liver, Biliary, Pancreas, Transplantation, Research, Special Reports, Editorials, Review Articles, Brief Communications, Clinical Summary, Clinical Images and Case Reports. It also deals with the basic sciences and experimental work. The journal is abstracted and indexed in SCI-E, IM/MEDLINE, EMBASE/EM, CA, Scopus, ScienceDirect, etc.
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