• Kei Naito, Kazuyasu Shinmura, Takayuki Suzuki, Shintaro Maeda, Satoshi Kuboki, and Masayuki Ohtsuka.
• Department of Surgery, Saitama Red Cross Hospital, Japanese Red Cross Society, Saitama, Japan.
• Medicine (Baltimore). 2024 Oct 4; 103 (40): e39954e39954.

BackgroundDespite the progress in surgical techniques and perioperative managements, the incidence of postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP) remains high. Recently, pancreatic dissection using a linear stapler has been widely performed; however, risk factors influencing the occurrence of POPF after DP using a liner stapler is not fully understood. The purpose of this paper was to evaluate whether the relations between staple height and pancreatic thickness or main pancreatic duct (MPD) diameter influenced the incidence of POPF.MethodsPatients who underwent DP without other organ resections between 2015 and 2022 were retrospectively reviewed. Compression Index (CI) was defined as staple height/pancreatic thickness, and Suturing Index (SI) was defined as staple height/ MPD diameter.ResultsIn 51 patients undergoing DP, 16 patients (31.4%) developed POPF. ROC analyses revealed that lower CI and higher SI significantly increased the incidence of POPF, and the cutoff values were 0.186 and 0.821, respectively. Univariate and multivariate analyses revealed that CI ≤ 0.186 and SI ≥ 0.821 were independent risk factors for POPF after DP. Moreover, the incidence of POPF in patients fulfilling both CI > 0.186 and SI < 0.821 was 5.9%, which was extremely lower than in those without fulfilling the criteria (44.1%), suggesting that this new criteria in combination with CI and SI was an excellent predictor of POPF.ConclusionsIt is possible that stapler cartridge selection using our new criteria in combination with CI and SI may reduce the incidence of POPF.Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.

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