Slovenská chirurgia 1e/2026

Clinically relevant postoperative fistula after proximal pancreatic resections: a retrospective analysis of a patient cohort in the 2020–2025 follow-up period

Introduction: Postoperative pancreatic fistula (POPF) is the most feared complication after pancreatic resections, which is responsible for the main cause of morbidity and mortality.

Material and methods: This is a retrospective study, the aim of which is to provide our experience with this complication. In the work, we evaluated patients during the period from January 1, 2020 to January 1, 2025, in whom cephalic duodenopancreatectomy with creation of pancreaticojejunal anastomosis using the “duct to mucosa” method according to the Cattell-Warren procedure was performed.

Results: From the total number of patients (n = 111) who underwent proximal pancreatic resection, 11 patients (9.9%) who underwent Whipple surgery laparoscopically were excluded. The study group therefore represented 100 patients in whom we evaluated clinically relevant POPF. Of this number, we recorded POPF B, C in 12 cases (12%). POPF B occurred in 8 patients (8%) and POPF C in 4 patients (4%). From the analyzed set, we confirmed that significant risk factors are male gender, soft consistency of the gland, narrow pancreatic duct and overweight.

Conclusion: Clinically relevant POPF even in highly specialized workplaces represents a huge problem and according to some studies it can reach up to 41%. Given the complexity of the issue, which includes a multidisciplinary approach, pancreatic resections should be performed in tertiary, highly specialized workplaces.

Keywords: postoperative pancreatic fistula (POPF), cephalic duodenopancreatectomy, proximal pancreatic resection