Association between clinically relevant postoperative pancreatic fistula and late hemorrhage after pancreaticoduodenectomy for periampullary cancer

Abstract

Background: Late postpancreatectomy hemorrhage is a rare but lifethreatening complication with high mortality. The role of clinically relevant postoperative pancreatic fistula (CR-POPF) in its pathogenesis remains unclear. Objective: To evaluate the incidence and analyze the association between pancreatic fistula and the risk of late hemorrhage after pancreaticoduodenectomy. Methods: A retrospective study was conducted on 56 patients undergoing pancreaticoduodenectomy for periampullary cancer at Bach Mai Hospital from January to December 2025. Logistic regression analysis was used to identify risk factors for late hemorrhage. Results: The postoperative mortality rate was 1.8%. Hemorrhage occurred in 16.1% of cases, of which 77.78% were late hemorrhage. Multivariate analysis demonstrated that CR-POPF (grade B/C) was an independent risk factor for late hemorrhage (OR = 16.67; 95% CI: 2.17–128.18; p = 0.007). Mild cases were managed conservatively, whereas hemodynamically unstable patients required emergency surgery. Conclusion: CR-POPF plays a key role in the pathogenesis of late hemorrhage after pancreaticoduodenectomy and significantly increases its risk. Effective control of pancreatic fistula is crucial for improving outcomes and reducing mortality.