Alternative Fistula Risk Score for Pancreatoduodenectomy (a-FRS)

Mungroop, Timothy H.; Rijssen, L.B. van; Klaveren, David van; Smits, F. Jasmijn; Woerden, Victor van; Linnemann, R.; Pastena, Matteo De; Klompmaker, Sjors; Marchegiani, Giovanni; Ecker, Brett L.; Dieren, Susan van; Bonsing, Bert A.; Busch, Olivier R.; Dam, Ronald M. van; Erdmann, Joris I.; Eijck, Casper H. van; Gerhards, Michael F.; Goor, Harry van; Harst, Erwin van der; Hingh, Ignace H. J. T. de; Jong, Koert P. de; Kazemier, Geert; Luyer, Misha; Shamali, Awad; Barbaro, Salvatore; Armstrong, Thomas; Takhar, Arjun; Hamady, Zaed; Klaase, Joost M.; Lips, Daan J.; Molenaar, I. Quintus; Nieuwenhuijs, Vincent B.; Rupert, C.; Santvoort, Hjalmar C. van; Scheepers, Joris J.; Schelling, George P. van der; Bassi, Claudio; Vollmer, Charles M.; Steyerberg, Ewout W.; Hilal, Mohammed Abu; Koerkamp, Bas Groot; Besselink, Marc G.

doi:10.1097/sla.0000000000002620

Cited by 266 publications

(154 citation statements)

References 43 publications

Supporting

Mentioning

140

Contrasting

Unclassified

Order By: Relevance

“…In this study, we demonstrated that pancreatic stulas occurred after PD in 24% patients, a nding similar to those in other studies 13 . Like previous studies 14 , our results showed that a small pancreatic duct, DM, and a non-pancreatic cancer pathology were predictive factors for pancreatic leakage after PD. Moreover, parameters associated with body composition, including BMI, AFA, and SMV distance, were identi ed as predictors.…”

Section: Discussionsupporting

confidence: 88%

See 1 more Smart Citation

Usefulness of the abdominal fat area-based risk score for postoperative pancreatic fistula after pancreatoduodenectomy

Endo

Kitago

Shinoda

et al. 2020

Preprint

View full text Add to dashboard Cite

BackgroundPancreatic fistulas remain a significant concern after pancreatectomy, and it is not possible to perform preoperative risk stratification for all patients. This study aimed to evaluate the usefulness of a unique risk model, based on the abdominal fat area (AFA) calculated by computed tomography, for pancreatic fistula development after pancreatoduodenectomy and compare it with models based on the body mass index (BMI) or abdominal thickness.Material and Methods Patient characteristics, preoperative laboratory data, radiographic findings, and their association with pancreatic fistula development after pancreaticoduodenectomy were analysed for 158 patients who underwent resection between 2011 and 2017. Clinically relevant postoperative pancreatic fistulas (CR-POPF) were defined as Grade B or C fistulas based on the International Study Group of Pancreatic Surgery (ISGPS) 2016 consensus.ResultsCR-POPF developed in 38 patients (24.2%). Multivariate logistic analysis indicated that the AFA, BMI, and intra-abdominal thickness were potential candidates for predictive models for pancreatic fistula development, small pancreatic duct diameter, diabetes mellitus development, and the pathology of non-pancreatic cancers. When comparing the three risk models (AFA-, BMI-, and intra-abdominal thickness-based), the AFA-derived risk model was superior to the BMI-based and intra-abdominal thickness-based risk stratification models (area under the curve 0.836 vs 0.824 vs 0.826).Conclusions The risk model based on AFA calculation was superior to that based on BMI or intra-abdominal thickness measurements. The model must be validated further to elucidate the efficacy of the risk scoring system in more detail.

show abstract

Section: Discussionsupporting

confidence: 88%

“…Among them, the AFA model showed a greater AUC than did the BMI model and SMV distance model. There have been several risk scoring systems for predicting CR-POPF after pancreaticoduodenectomy 9,14 ; however, our study provides new insight into the usefulness of the AFA for predicting CR-POPF.…”

Section: Discussionmentioning

confidence: 90%

Usefulness of the abdominal fat area-based risk score for postoperative pancreatic fistula after pancreatoduodenectomy

Endo

Kitago

Shinoda

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…The diameter of main pancreatic duct has been considered to be a key risk factor for POPF after pancreaticoduodenectomy [32,33]. However, it has not been proven to be a risk factor for POPF after DP in our work.…”

Section: Discussionmentioning

confidence: 65%

“…The soft pancreas has been regarded as a key risk factor for POPF, especially for a pancreatoduodenctomy [32,33]. In this cohort study, 86 cases, 23 of which developed a POPF, were classified as having soft pancreas.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for pancreatic fistula following distal pancreatectomy: a retrospective study of 211 consecutive patients

Shen

Zhang

et al. 2019

Preprint

View full text Add to dashboard Cite

Background Postoperative pancreatic fistula (POPF) is a common complication following distal pancreatectomy (DP). Although the mortality from these procedures has decreased in the past decades, the rate of POPF remains high. The aim of this study was to identify risk factors associated with POPF after DP. Methods A retrospective review of a consecutive series of 211 patients who had undergone DP between January 2016 and October 2018 at a single institution was conducted. Patient demographic data, perioperative data and clinicopathological parameters were analysed to evaluate their correlation with the incidence of POPF using univariate and multivariate models. POPFs were defined by 2016 International Study Group criteria. Results Two hundred eleven consecutive patients were identified. The overall pancreatic fistula rate was 15.64%, and no 30-day or 90-day mortality was seen. Four predictors were independently associated with POPF: soft pancreatic texture (odds ratio (OR): 4.23, 95% confidence interval (CI): 1.71-10.45, P = 0.002), longer operating time (OR: 4.18, 95% CI: 1.67–10.46, P = 0.002), higher difference of albumin (OR: 6.41, 95% CI: 2.40–17.08, P <0.001), and history of cardiovascular disease(OR: 5.05, 95% CI: 1.97-13.01, P = 0.001). Conclusions Although DP can be performed with a low rate of mortality, POPF remains a common complication. Pancreatic texture, operating time, the difference of albumin and cardiovascular disease were risk factors for POPF after DP.

show abstract

“…Many risk factors have been identified for POPF after PD. Among which, BMI, pancreatic texture, and duct diameter have been developed as an alternative fistula risk score [39]. The importance of the above three parameters was once again externally validated by our study.…”

Section: Discussionmentioning

confidence: 66%

Clinical significance of drain fluid culture after pancreaticoduodenectomy

Yang

Jin

et al. 2018

J Hepato Biliary Pancreat

View full text Add to dashboard Cite

Background The mechanism of infected postoperative pancreatic fistula (POPF) following pancreaticoduodenectomy (PD) is undefined. Drain amylase has been used to predict POPF, whereas little data are available about the value of drain fluid culture. The aim was to investigate the incidence, risk factors and association with surgical outcomes of positive drainage culture (PDC) after PD. Methods A single‐center retrospective analysis was conducted of prospectively collected data from patients who underwent PD between January 2005 and December 2015. Drain fluid samples were obtained for microbiological analysis after surgery. Risk factors for PDC were evaluated, and its influence on surgical outcomes was explored. Results Of 768 patients, 261 (34%) had PDC during the postoperative period. Among them, a total of 434 isolates were yielded. One hundred and seven (24.7%) were Gram‐positive, 283 (65.2%) Gram‐negative, and 44 (10.1%) fungi. Multivariate analysis revealed that body mass index (BMI) ≥25 kg/m2, preoperative chemoradiation and intra‐operative red blood cell transfusion were independent risk factors for PDC. PDC was associated with higher incidences of complications including POPF, major complications and reoperation, but with no correlation between the day of PDC and complications. BMI ≥25 kg/m2, early PDC (≤3 days), main pancreatic duct <3 mm, and soft pancreas were revealed as independent predictors for POPF. There was a correlation between type of microorganisms and complications. Conclusion Considering the correlation between PDC and postoperative complications, preventive measures are crucial to improve outcomes after PD. Whether antibiotic treatment for early PDC will alter the clinical course of POPF needs further evaluation.

show abstract

Alternative Fistula Risk Score for Pancreatoduodenectomy (a-FRS)

Abstract: The a-FRS predicts POPF after pancreatoduodenectomy based on 3 easily available variables (pancreatic texture, duct diameter, BMI) without blood loss and pathology, and was successfully validated for both the 2005 and 2016 POPF definition.

Cited by 266 publications

References 43 publications

Usefulness of the abdominal fat area-based risk score for postoperative pancreatic fistula after pancreatoduodenectomy

Usefulness of the abdominal fat area-based risk score for postoperative pancreatic fistula after pancreatoduodenectomy

Risk factors for pancreatic fistula following distal pancreatectomy: a retrospective study of 211 consecutive patients

Clinical significance of drain fluid culture after pancreaticoduodenectomy

Contact Info

Product

Resources

About