A simple nomogram for early postoperative risk prediction of clinically relevant pancreatic fistula after pancreatoduodenectomy

Abstract

Purpose Postoperative pancreatic fistulae (POPF) present a serious and life-threatening complication after pancreatic head resections (PD). Therefore, reliable risk stratification to identify those at risk is urgently needed. The aim of this study was to identify postoperative laboratory parameters for the prediction of POPF in the early postoperative period. Methods One hundred eighty-two patients who underwent PD from 2012 until 2017 were retrospectively analyzed. Multivariate logistic regression was performed using the GLM (general linear model) method for model building. Two nomograms were created based on the GLM models of postoperative day one and postoperative day one to five. A cohort of 48 patients operated between 2018 and 2019 served as internal validation. Results Clinically relevant pancreatic fistulae (CR-POPF) were present in 16% (n = 29) of patients. Patients with CR-POPF experienced significantly more insufficiencies of gastroenterostomies, delayed gastric emptying, and more extraluminal bleeding than patients without CR-POPF. Multivariate analysis revealed multiple postoperative predictive models, the best one including ASA, main pancreatic duct diameter, operation time, and serum lipase as well as leucocytes on day one. This model was able to predict CR-POPF with an accuracy of 90% and an AUC of 0.903. Two nomograms were created for easier use. Conclusion Clinically relevant fistula can be predicted using simple laboratory and clinical parameters. Not serum amylase, but serum lipase is an independent predictor of CR-POPF. Our simple nomograms may help in the identification of patients for early postoperative interventions.

Development and validation of a network calculator model for safety and efficacy after pancreaticoduodenectomy in the elderly patients with pancreatic head cancer

“…Therefore, we innovatively included it in a nomogram model for investigation. A high ASA (> = 3) often means that the patient is older, has underlying diseases, and has a higher degree of pancreatic fibrosis, resulting in a much lower survival rate in these patients 34 . Also, previous studies have found that a higher ASA is associated with severe postoperative complications in pancreatic cancer patients, severely threatening perioperative safety and their long‐term survival 35 …”

“…A high ASA (> = 3) often means that the patient is older, has underlying diseases, and has a higher degree of pancreatic fibrosis, resulting in a much lower survival rate in these patients. 34 Also, previous studies have found that a higher ASA is associated with severe postoperative complications in pancreatic cancer patients, severely threatening perioperative safety and their long-term survival. 35 CA19-9 level and maximum tumor diameter are closely related to the development of the tumor itself, which have been frequently investigated in previous studies.…”

Serum Creatinine and Amylase in Drain to Predict Pancreatic Fistula Risk after Pancreatoduodenectomy

“…Like POD1 DFA, serum markers are not reliant on subjective judgement and can be used in dynamic risk monitoring. Several markers including serum amylase [7], lipase [21,22], interleukin-6 [22], WBC [23], and CRP [24] have been found to correlate with CR-POPF. Therefore, stratifying risk based on a Several serum markers were routinely assessed in our department, such as CRP, WBC count, and aspartate transaminase.…”

Optimizing prediction models for pancreatic fistula after pancreatectomy: Current status and future perspectives

“…The surgical approach utilized (open, laparoscopic, and robotic) and type of anastomosis are also important. Other intraoperative risk factors include extended operating time, massive blood loss, combined venous resection, and extended lymphadenectomy[ 20 - 23 ].…”