Shorter Pancreatic Division-To-Anastomosis Time Reduces Drain Amylase Levels After Pancreatoduodenectomy for Nonpancreatic Cancer.

Background: Despite advances in surgical techniques, postoperative pancreatic fistula (POPF) remains a major concern after pancreatoduodenectomy (PD). Although various risk factors have been identified, most are patient-specific and nonmodifiable. This study investigated whether the time from pancreatic division to anastomosis (division-to-anastomosis time, DAT) influences postoperative outcomes.

Methods: We retrospectively analyzed 182 patients who underwent PD for nonpancreatic cancer between 2017 and 2022. The relationship between DAT and drain amylase (D-amy) levels on postoperative day 3 was evaluated. We also investigated the association between DAT and POPF development. Multiple regression analyses were performed to adjust for potential confounding factors.

Results: Median patient age was 72 years, and 64.8% were male. Primary diagnoses included distal bile duct (35.7%), ampullary (24.7%), and duodenal (7.7%) cancers. Longer DAT was independently associated with increased D-amy levels (regression coefficient 0.16, 95% confidence interval: 0.0-0.29), with each hourly increase in DAT corresponding to a 1.45-fold increase. Grade B POPF occurred in 48% of cases. Multivariate analysis identified prolonged DAT and higher BMI as independent POPF risk factors.

Conclusions: Prolonged DAT during PD was associated with increased D-amy levels and POPF incidence. As a modifiable surgical factor, DAT represents a potential target for technical refinement to improve postoperative outcomes.