Association between Main Pancreatic Duct Size, Comorbidities, and Fistula Formation after Whipple Procedure for Pancreatic Cancer

OBJECTIVE: Studies have associated abnormally dilated or constricted main pancreatic duct (MPD) diameter sizes in postproximal pancreatectomies (Whipple procedures) with postoperative complications. As such, we studied the clinical factors associated with both abnormally dilated or constricted MPD diameters and perioperative factors that may influence postoperative pancreatic fistula formation. METHODS: We analyzed Whipple procedure cases for pancreatic cancer in the 2019-2021 American College of Surgeons National Surgical Quality Improvement Program databases. We compared these three groups based on MPD diameter sizes: control group (3- to 6-mm MPD size, n=3529), small MPD (<3 mm, n=1399) cohort, and large MPD (>6 mm, n=1098) group. Moreover, soft pancreatic gland texture was observed significantly more often in the <3-mm proximal MPD diameter group. Multivariate logistic regression revealed that small duct size (<3 mm) and soft pancreatic gland texture were independently associated with pancreatic fistula formation following a Whipple procedure for pancreatic cancer. CONCLUSIONS: A <3-mm main pancreatic duct at the head of the pancreas was found to be associated with multiple postoperative complications following the Whipple procedure with pancreatojejunostomy, affecting both patient quality of life and hospital resource utilization. Healthcare providers can measure MPD size before surgery using computed tomography, which enables better anticipation, preparation, and potential mitigation of complications.