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Multicenter Study
. 2019 Jun;119(8):1128-1134.
doi: 10.1002/jso.25464. Epub 2019 Apr 5.

Preoperative risk evaluation for pancreatic fistula after pancreaticoduodenectomy

Ryan J Ellis  1   2 , D Brock Hewitt  2   3 , Jason B Liu  1   4 , Mark E Cohen  1 , Ryan P Merkow  2 , David J Bentrem  2 , Karl Y Bilimoria  1   2 , Anthony D Yang  2
Affiliations
Multicenter Study

Preoperative risk evaluation for pancreatic fistula after pancreaticoduodenectomy

Ryan J Ellis et al. J Surg Oncol. 2019 Jun.

Abstract

Background: Pancreatic fistula remains common, with limited ability to risk stratify patients preoperatively. The objective of this study was to identify risk factors for clinically-relevant postoperative pancreatic fistula (CR-POPF) that are routinely available in the preoperative setting.

Methods: Preoperatively available variables for all pancreaticoduodenectomies from 2014-2017 were examined using a national clinical registry. The cohort was separated into risk factor identification and internal validation subgroups.

Results: Among 15 033 pancreaticoduodenectomies, the CR-POPF rate was 16.7%. CR-POPF was more likely in patients that were male (odds ratio [OR], 1.51), obese (body mass index [BMI] > 30, OR, 1.97), had minimal preoperative weight loss (OR, 1.25), had a nondilated pancreatic duct (OR, 1.81), did not have diabetes, (OR, 1.80), did not receive neoadjuvant therapy (OR, 1.78), had no evidence of biliary obstruction (OR, 1.18), or had nonadenocarcinoma pathology (OR, 1.96; all P < 0.01). Patients with three or fewer risk factors had a CR-POPF rate of 7.1%, while those with six or more risk factors had a CR-POPF rate of 26.3% (P < 0.001).

Conclusion: Preoperative CR-POPF risk evaluation could be a useful tool in patient counseling and surgical planning, and risk may allow for more well-informed decisions regarding perioperative management, including enhanced recovery protocols and use of somatostatin analogs.

Keywords: Whipple procedure; pancreatic fistula; pancreatic surgery; pancreaticoduodenectomy.

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Conflict of interest statement

CONFLICT OF INTERESTS

The authors declare that they have no conflict of interests.

Figures

FIGURE 1
FIGURE 1
CR-POPF rates based on preoperative risk factors in derivation and validation cohorts. Rate of CR-POPF based on number of risk factors in both derivation and validation cohort. Fistula rates in the derivation cohort were 7.1% with three or fewer risk factors, 14.0% with four or five, and 26.3% with six or more risk factors. Fistula rates in the validation cohort ranged from 6.7% with fewer than three risk factors to 27.1% with six or more risk factors. CR-POPF, clinically-relevant postoperative pancreatic fistula
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