Risk Factors and a New Prediction Model for Pancreatic Fistula After Pancreaticoduodenectomy

Abstract

In order to find the risk factors of postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD) according to the latest definition and grading system of International Study Group of Pancreatic Surgery (ISGPS) (version 2016) and propose a nomogram for predicting POPF. Methods: We conducted a retrospective analysis of 232 successive cases of PD performed at our hospital by the same operator from August 2012 to June 2020. POPF was diagnosed in accordance with the latest definition of pancreatic fistula from the ISGPS. The risk factors of POPF were analyzed by univariate and multivariate logistic regression analysis. A nomogram model to predict the risk of POPF was constructed based on significant factors. Results: There were 18 cases of POPF, accounting for 7.8% of the total. Among them, 17 cases were classified into ISGPF grade B and 1 case was classified into ISGPF grade C. In addition, 35 cases were classified into biochemical leak. Univariate and multivariate analysis showed that hypertension, non-diabetes, no history of abdominal surgery, antecolic gastrojejunostomy and soft pancreas were independent risk factors of POPF. Based on significant factors, a nomogram is plotted to predict the risk of POPF. The C-index of this nomogram to assess prediction accuracy was 0.916 (P < 0.001) indicating good prediction performance. Conclusion: Hypertension, non-diabetes, no history of abdominal surgery, antecolic gastrojejunostomy and soft pancreas were independent risk factors of POPF. Meanwhile, a nomogram for predicting POPF with good test performance and discriminatory capacity was constituted.

Preoperative risk factors in predicting the development of postoperative pancreatic fistulas

“…According to other studies, no associations were found between the preoperative values of hemoglobin and the incidence of pancreatic fistula [1], and this fact was also observed in our study group. The onset of postoperative pancreatic fistula was not influenced by hemoglobin levels or the preexisting anemia.…”

Incidence of clinically relevant postoperative pancreatic fistula in patients undergoing open and minimally invasive pancreatoduodenectomy: a population-based study

“…While some variables overlap with those reported in this study, a key distinction to these risk score models relates to patient selection. More recent predictive models based on the new International Study Group on Pancreatic Surgery definition included novel factors such as extended lymphadenectomy, serum albumin levels, and hypertension, but are restricted to single institutions and few operative factors were identified [ 10 , 33 , 34 ]. These aforementioned risk score and predictive models do not discriminate between various grades or clinical relevance of POPF.…”

Robotic enucleation & uncinectomy of complex lesions of the proximal pancreas

“…Global data suggests that robotic pancreas surgery is safe and feasible. 13 The uptake in utilization of this platform is rapidly increasing. The International Consortium on Minimally Invasive Pancreas Surgery (I-MIPS) developed the first evidence-based guidelines in 2020, addressing the use of robotic surgery.…”

“…Global data suggests that robotic pancreas surgery is safe and feasible 13 . The uptake in utilization of this platform is rapidly increasing.…”