Infusion therapy and acinar component of the pancreas as predictors of pancreatic fistula in pancreatoduodenectomy

Objective. To evaluate the effect of first-day infusion and pancreatic acinar structures on the incidence of postoperative pancreatic fistulas (POPF) and complications after pancreatoduodenectomy. Material and methods. A retrospective study included patients who underwent pancreatoduodenectomy in 2024. Results. There were 79 patients: group 1 (n=38) — infusion ≥4.5 ml/kg/h on day 1, group 2 (n=41) — infusion <4.5 ml/kg/h. The median of acinar structures was 65%. POPF were found in 23.6% (n=9) and 53.6% (n= 22) of patients, respectively (p=0.021). POPF type B prevailed (21.0% (n=8) and 51.2% (n=21) of patients, respectively, p=0.033). Clavien-Dindo grade III—V complications occurred in 26.3% (n=10) and 58.5% (n=24) of patients, respectively (p=0.022). Multifactorial analysis showed that daily infusion <4.5 ml/kg/h (OR=3.938; 95% CI 1.461—10.614; p=0.025) and acinar structures ≥65% (OR=12.889; 95% CI 4.285—38.772; p=0.001) were predictors of type B POPF. Acinar structures ≥65% were predictors of Clavien-Dindo grade ≥III complications (OR=11.487; 95% CI 3.853—34.243; p=0.003). Conclusion. Daily infusion <4.5 ml/kg/h (p=0.025) and acinar structures ≥65% (p=0.001) increase the incidence of type B POPF after pancreatoduodenectomy. Acinar structures ≥65% increase the incidence of Clavien-Dindo ≥ grade III complications (p=0.003).