Predictive Factors of Pancreatic Fistula After Pancreaticoduodenectomy and External Validation of Predictive Scores

Abstract

Background/Aim: The Fistula Risk Score (FRS), as other risk scores, is a validated model predicting the development of a clinically relevant post-operative pancreatic fistula (CR-POPF) after pancreaticoduodenectomy (PD). We evaluated risk factors related with CR-POPF and correlated four predictive scores with the likelihood of developing CR-POPF in our cohort. Patients and Methods: The records of 107 patients who underwent PD from 2007 to 2015 were obtained from a prospectively maintained database and reviewed. CR-POPFs were categorized by the International Study Group of Pancreatic Fistula (ISGPF) standards. Firstly, a univariate and multivariate analysis of risk factors related to CR-PPOPF was performed, and then the data were correlated with FRS, Wellner's, Robert's and Yamamoto's scores. Results: In total, 30 patients developed a CR-POPF. On multivariate analysis, abdominal thickness (OR=1.02, p=0.010), Wirsung's duct diameter (OR=0.57, p=0.029), pancreatic consistency (OR=3.18, p=0.011) and histological diagnosis of the lesion (OR=1.65, p=0.012) represented independent predictive factors of CR-POPF. FRS (R 2 =0.596, p=0.001), Wellner's score (R 2 =0.285, p=0.005) and Roberts' score (R 2 =0.385, p=0.002) correlated with the likelihood of developing CR-POPF. Conclusion: Abdominal thickness, Wirsung's duct diameter, pancreatic consistency and histological diagnosis were independent predictive factors of CR-POPF. Predictive scores reflected the likelihood of CR-POPF, FRS being the score with the highest predictive value.

Systematic review and meta‐analysis of factors associated with post‐operative pancreatic fistula following pancreatoduodenectomy

“…Some 23 665 patients had malignant disease and of these 12 097 had pancreatic ductal adenocarcinoma, 3778 distal cholangiocarcinoma, 3189 ampullary carcinoma and 1456 duodenal carcinoma. Study characteristics are summarized in Table S3 14–126 . Ninety‐one studies were retrospective cohort studies, 28 prospective cohort studies and three randomized controlled trials.…”

The image-based preoperative fistula risk score (preFRS) predicts postoperative pancreatic fistula in patients undergoing pancreatic head resection

“…in 2013 3 , incorporates the risk factors for POPF development recognized by the International Study Group of Pancreatic Fistula: small pancreatic duct diameter, soft pancreatic texture, high-risk pathology and excessive intraoperative blood loss. The value of these variables, however, is controversially discussed, and association analyses have demonstrated differential relevance and significance of the contributing parameters 10 , 11 . While soft pancreatic texture and small pancreatic duct diameter are highly predictive of POPF development, recent studies imply no relevant association of high-volume intraoperative blood loss with a significantly increased risk of POPF development 8 , 10 – 13 .…”

Cirugía electiva durante la pandemia por SARS-CoV-2 (COVID-19): análisis de morbimortalidad y recomendaciones sobre priorización de los pacientes y medidas de seguridad

“…La toma de decisiones sobre el tratamiento má s adecuado para cada paciente deberá realizarse a travé s de un comité multidisciplinar, basá ndose en los siguientes factores: a) Riesgo de complicaciones relacionadas con el paciente (Clasificació n anesté sica preoperatoria ASA, ECOG) 21,31 . b) Riesgo de complicaciones relacionadas con la enfermedad, su progresió n y el procedimiento quirú rgico [32][33][34][35] . c) Disponibilidad de alternativas terapé uticas a la cirugía de menor riesgo (quimioterapia, radioterapia, procedimientos endoscó picos, termoablació n, etc.)…”