Flow relevant stenosis of the celiac artery is an independent risk factor for postoperative pancreatic fistula: results of a retrospective, multicentre, international cohort study

Introduction Postoperative pancreatic fistula (POPF) is the most feared complication after pancreatic resections. We studied whether the presence of a flow relevant stenosis of visceral arteries was associated with a higher morbidity and mortality rate.

Methods All consecutive patients who underwent a pancreaticoduodenectomy in two university hospitals between 1 January 2010 and 31 December 2019 were included. Flow relevant stenosis was defined as a stenosis ≥70% in the first 3 cm of coeliac artery (CA) or superior mesenteric artery (SMA) on a CT-scan. Univariate and multivariate analysis were performed to study the association between stenosis of CA, stenosis of SMA, sex, age, BMI, and ASA score in relation to major complications including death, POPF, bleeding, and ischemia.

Results 837 patients were included in the analysis, of whom 128 patients (15,3%) presented with a flow relevant stenosis of the CA and 28 patients (3,3%) with a flow relevant stenosis of the SMA. In both univariate and multivariate analyses, the presence of flow relevant stenosis of the CA (p=0.004, OR 1.98, 95% CI 1.24-3.17) and male gender (p< 0.001, OR 2.03, 95% CI 1.37-3.02) were significantly associated with the occurrence of clinically relevant POPF. No statistically significant difference was found in relation to major complications, bleeding and ischemia.

Conclusion Flow relevant stenosis of the CA is often occurring and an independent risk factor for POPF. Preoperatively, the CT-scan should be reviewed for the presence of flow relevant stenosis of the CA, and if present treated.

Publication History

Article published online:
07 September 2021