Fifteen years’ experience of Distal Pancreatectomy in a Tertiary Center: Trends, Outcomes and Challenges

Abstract

Background: Distal pancreatectomy (DP) is a standard surgical approach for managing various benign and malignant pancreatic lesions. Despite advancements, postoperative pancreatic fistula (POPF) remains a significant complication, and there is ongoing debate surrounding optimal surgical techniques and stump closure methods. Methods: This retrospective study reviewed 110 patients who underwent DP at Mansoura University between 2010 and 2024. Data included demographics, clinical presentation, operative details, and postoperative outcomes. The primary focus was identifying risk factors for POPF using statistical comparisons between patients with and without POPF. Results: POPF occurred in 27.5% of cases, predominantly Grade A. Significant predictors of POPF included reduced pancreatic stump thickness (2.7 ± 1.2 mm vs. 4.2 ± 0.6 mm, p < 0.0001), lower pancreatic thickness-to-duct (P/D) diameter ratio (1.7 ± 0.7 vs. 2.7 ± 1.2, p = 0.001), use of energy-based division (p = 0.01), and failure to close the pancreatic duct (p = 0.03). Results suggested increased POPF risk was noted with anterior duct position and increased blood loss. Omental covering showed a non-significant trend towards reduced POPF. Conclusions: Thinner pancreatic remnants, lower P/D ratios, energy-based division, and duct non-closure are associated with increased POPF risk following DP. Recognizing these risk factors can guide surgical decision-making to improve outcomes.