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

Anticancer Res. 2019 Jan;39(1):499-504. doi: 10.21873/anticanres.13140.

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 (R2=0.596, p=0.001), Wellner's score (R2=0.285, p=0.005) and Roberts' score (R2=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.

Keywords: Pancreatic fistula; pancreatic ductal adenocarcinoma; pancreatic surgery; pancreaticoduodenectomy; predictive scores.

MeSH terms

  • Adult
  • Aged
  • Anastomosis, Surgical / adverse effects
  • Female
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Pancreas / physiopathology
  • Pancreas / surgery*
  • Pancreatic Ducts / physiopathology
  • Pancreatic Ducts / surgery
  • Pancreatic Fistula / epidemiology
  • Pancreatic Fistula / physiopathology*
  • Pancreatic Fistula / surgery
  • Pancreaticoduodenectomy / adverse effects*
  • Postoperative Complications / epidemiology
  • Postoperative Complications / physiopathology*
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors