The impact of body mass index on predicting postoperative pancreatic fistula in relation to pancreatic texture and main pancreatic duct diameter after pancreaticoduodenectomy

Abstract

Introduction

Pancreaticoduodenectomy (PD) remains the primary radical treatment for malignant periampullary tumors. Clinically relevant postoperative pancreatic fistula (POPF) develops in 15–20% of patients. Body mass index (BMI) may influence the risk of this complication. The aim of our study was to assess the impact of BMI, pancreatic texture, and main pancreatic duct diameter on the risk of POPF after PD.

Methods

A retrospective cohort study included 106 patients who underwent PD for malignant periampullary tumors between 2018 and 2024, performed by a single surgical team at a major center in Ukraine. Patients were grouped according to a classification proposed by the International Study Group for Pancreatic Surgery (ISGPS) based on pancreatic texture and duct diameter: Group A: not-soft texture, duct > 3 mm. Group B: not-soft texture, duct ≤ 3 mm. Group C: soft texture, duct > 3 mm. Group D: soft texture, duct ≤ 3 mm.

Results

Group A included 63 patients, Group B 9, Group C 8, and Group D 26. No significant association between BMI and POPF was found in Groups A, B, and C. However, in Group D, patients with BMI ≥ 25 had a significantly higher rate of POPF compared to those with BMI < 25.

Conclusion

Increased BMI was significantly associated with a higher risk of POPF only in patients with a soft pancreatic texture and a main pancreatic duct diameter ≤ 3 mm.