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Predictors of Postoperative Pancreatic Fistula (POPF) After Pancreaticoduodenectomy: Clinical Significance of the Mean Platelet Volume (MPV)/Platelet Count Ratio as a New Predictor

  • Original Article
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Journal of Gastrointestinal Surgery

Abstract

Purpose

In this study, it was aimed to determine the predictors of clinically relevant postoperative pancreatic fistula (CR-POPF) following pancreaticoduodenectomy (PD) and clinical significance of mean platelet volume (MPV)/total platelet count ratio (MPR) as a new predictor for CR-POPF.

Methods

A total of 105 patients who underwent PD consecutively due to periampullary located diseases were included in the study. Patients were divided into two groups as CR-POPF and no postoperative pancreatic fistula (No-POPF). Demographic parameters, preoperative serum-based inflammatory indicators, surgical procedures, intraoperative findings, and histopathological parameters were recorded retrospectively from prospectively recorded patient files and compared between the groups.

Results

CR-POPF occurred in 16 (15.2%) patients: 8 (7.6%) were grade B and 8 (7.6%) were grade C according to the ISGPF classification. In univariate analysis, intraoperative blood loss > 580 mL (OR: 5.25, p = 0.001), intraoperative blood transfusion (OR: 5.96, p = 0.002), intraoperative vasoconstrictor medication (OR: 4.17, p = 0.014), benign histopathology (OR: 3.51, p = 0.036), and poor differentiation in malignant tumors (OR: 4.07, p = 0.044) were significantly higher in the CR-POPF group, but not significant in multivariate analysis. Soft pancreatic consistency (OR: 6.08, p = 0.013), pancreatic duct diameter < 2.5 mm (OR: 17.15, p < 0.001), and MPR < 28.9 (OR: 13.91, p < 0.001) were the independent predictors of CR-POPF according to multivariate analysis. Neoadjuvant treatment history and simultaneous vascular resection were less likely to cause CR-POPF development; however, they were insignificant.

Conclusion

Soft pancreatic consistency, pancreatic duct diameter, and preoperative MPR were the independent predictors of CR-POPF following PD. Decreased MPR is a strong predictor for CR-POPF and should be considered when deciding treatment strategies.

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Authors and Affiliations

  1. Department of Surgical Oncology, Faculty of Medicine, Fırat University Medical Faculty Hospital, Elazig, 23200, Turkey

    Azmi Lale, Veysel Karahan, Remzi Kurt & Erhan Aygen

  2. Department of Gastrointestinal Surgery, Aydin State Hospital, Aydin, Turkey

    Ilter Kirmizi

  3. Department of Biostatistics and Medical Informatics, School of Medicine, Firat University, Elazig, Turkey

    Betul Dagoglu Hark

  4. Department of General Surgery, Erciyes University Medical Faculty Hospital, Kayseri, Turkey

    Turkmen Bahadir Arikan

  5. Department of Medical Oncology, Fırat University Medical Faculty Hospital, Elazig, Turkey

    Nilgün Yıldırım

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  1. Azmi Lale
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Correspondence to Azmi Lale.

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The requirement for obtaining written informed consent from each patient was waived because of the study’s retrospective design.

Ethical Considerations

This study was approved by the institutional review board and was conducted in accordance with the Declaration of Helsinki and Good Clinical Practice. This article does not contain any studies with human participants or animals performed by any of the authors.

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Lale, A., Kirmizi, I., Hark, B.D. et al. Predictors of Postoperative Pancreatic Fistula (POPF) After Pancreaticoduodenectomy: Clinical Significance of the Mean Platelet Volume (MPV)/Platelet Count Ratio as a New Predictor. J Gastrointest Surg 26, 387–397 (2022). https://doi.org/10.1007/s11605-021-05136-5

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