Postoperative Pancreatic Fistula in Surgery for Perihilar Cholangiocarcinoma

Background There are numerous studies on postoperative pancreatic fistula (POPF) in pancreatic surgery but few studies on POPF in extrahepatic bile duct resection with or without hepatectomy for perihilar cholangiocarcinoma (PHCC). The aim of this study is to investigate the incidence of and risk factors for POPF in this challenging surgery. Methods All consecutive patients who underwent surgical resection for presumed PHCC between January 2008 and December 2017 were retrospectively reviewed, with special attention paid to POPF. Results Among 416 patients, 90 patients showed a drain amylase level of > 3 times the normal limit on day 3 or after. The severity of POPF was biochemical leakage in 46 patients and grade B in 44 patients. No patient had grade C POPF; thus, the incidence of clinically relevant POPF was 10.6% (44/416). The resection line of the common bile duct was closely associated with POPF; 23 (27.7%) of the 83 patients who underwent intrapancreatic resection of the common bile duct developed POPF. The occurrence of intra-abdominal abscess and liver failure was significantly higher in patients with POPF, but the 90-day mortality was similar. The multivariate analysis identified a body mass index of ≥ 22 and intrapancreatic bile duct resection as independent risk factors for POPF. Conclusions POPF occurs in approximately 10% of patients undergoing resection for PHCC. Careful postoperative management with attention to POPF is required, especially in patients who undergo intrapancreatic resection of the common bile duct and in those with a high body mass index.