Predictors and outcomes of pancreatic fistula grade C after pancreatoduodenectomy

Objective. To identify the risk factors for conversion of type B pancreatic fistula to type C fistula and to evaluate the immediate outcomes of pancreaticoduodenectomy (PD) in this complication. Material and methods. A retrospective study enrolled 1.083 patients who underwent PD between 2011 and 2024. Clinically significant PF developed in 273 (25.2%) patients. Of these, 52 (19%) ones were diagnosed with type C fistula. Clinical and demographic parameters, intraoperative data, and postoperative outcomes were analyzed. Results. Mortality among patients with type C fistula requiring relaparotomy was 63.4% (26/41), among patients without relaparotomy — 100% (11/11, p=0.022). Postoperative course in type C PF was significantly more often complicated by pneumonia (p<0.001) and ulcerative bleeding (p=0.001). Independent factors correlating with transition from type B to type C were pancreatodigestive anastomosis leakage (AOR=3.516; p=0.035), high body mass index (29 kg/m2) (AOR=1.153; p=0.022), preoperative common bile duct stenting (AOR=3.793; p=0.018), and coronary artery disease (exertional angina) (AOR=4.894; p=0.005). Conclusion. Type C PF after PD remains a complication with extremely high mortality rate. The identified complex of preoperative and intraoperative risk factors should allow us to identify patients requiring special attention and, possibly, individual perioperative management to prevent poor outcomes. Relaparotomy and open pancreatic fistula repair are extreme measures, reserved only for life-threatening complications that cannot be addressed with a minimally invasive approach.