NESS - Association of Intraductal Papillary Mucinous Neoplasm Pathology on the Risk of Postoperative Pancreatic Fistula: Insights from the National Surgical Quality Improvement Program.

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Association of Intraductal Papillary Mucinous Neoplasm Pathology on the Risk of Postoperative Pancreatic Fistula: Insights from the National Surgical Quality Improvement Program.
Amir Ebadinejad¹, Nora Singh^*², Sara Saeidishahri¹, Oscar Serrano¹
¹Department of Surgery, Hartford Hospital, Hartford, Connecticut, Hartford, CT; ²Frank H. Netter School of Medicine, Hamden, CT

Background: Intraductal Papillary Mucinous Neoplasms (IPMN) of the pancreas are increasingly detected due to improved imaging and heightened clinical awareness. As a result, surgical resections for IPMN have increased. Postoperative pancreatic fistula (POPF) is a common complication that can lead to abscesses, bleeding, and other serious complications. This study aims to analyze outcomes from POPF in a cohort of IPMN patients based on their histology.

Study Design: This retrospective study utilized data from the National Surgical Quality Improvement Program (NSQIP) for the years 2022 and 2023, including patients with IPMN who underwent pancreatectomy. Comparative analyses of patient demographics and outcomes were conducted using t-tests, Pearson�s chi-square, and Fisher�s exact tests. Subgroup analysis was conducted based on surgical resection�pancreaticoduodenectomy (PD) and distal pancreatectomy (DP)� and histology (benign, malignant) to assess differences in outcomes across procedures and histology. Stepwise regression was employed to identify risk factors for the development of POPF.

Results: Out of 1632 patients having surgery for IPMN, 1311 (80.3%) had benign IPMN (B-IPMN) while 321 (19.7%) had malignant IPMN (M-IPMN). M-IPMN patients were older (70.1 vs. 68.7 years, p=0.019) and had a lower BMI (27.1 vs. 28, p=0.02). B-IPMN patients more frequently had laparoscopic (37.4% vs. 23.4%, p<0.001) and robot-assisted procedures (28.4% vs. 17.1%, p<0.001). Clinically-significant POPF (grade B/C) was more prevalent in the B-IPMN group (16.4% vs. 8.8%, p<0.001). Mortality and major/minor complications were comparable between groups, but readmissions were more common for B-IPMN patients (19.6% vs. 14.0%, p=0.021). Surgical resections included 849 PD and 625 DP. In the PD subgroup, grade B/C POPF occurred more frequently in B-IPMN (21.7% vs. 10.7%, p=0.001) with increased readmissions (24.8% vs. 15.2%, p=0.008), whereas no significant differences were observed in the DP subgroup. Regression analysis revealed that B-IPMN (OR 2.045, p=0.037), male gender (OR 1.545, p=0.045), and intermediate or soft pancreatic gland texture (OR 2.671 and 2.31, p=0.017 and 0.005) were independent risk factors for POPF, whereas DP (OR= 0.606, p= 0.101) and larger pancreatic duct sizes (>6 mm and 3�6 mm) were protective (OR 0.416 and 0.517, p=0.005 and 0.004).

Conclusions: B-IPMN histology appears to confer an increased risk of clinically-significant POPF, independent of pancreatic duct size, gland texture, or other risk factors. This suggests that factors intrinsic to B-IPMN histology may contribute to POPF risk.

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