Identification of High-risk Patients of Clinically Relevant Postoperative Pancreatic Fistula

Abstract

Background: Pancreatic fistula (POPF) remains a significant concern after pancreaticoduodenectomy (PD). Recently, there have been the development of risk-stratification and increasing needs in the management base on such risk-model. The purpose of this study was to examine the identification of risk factor and the invention of risk-model using these risk factors. Methods: Patient characteristics, preoperative laboratory, and radiographic findings and their association with postoperative pancreatic fistula after pancreaticoduodenectomy were analyzed for 158 patients who underwent resection between 2011 and 2017. CR-POPF was defined as Grade B or C pancreatic fistula based on the International Study Group of Pancreatic Surgery (ISGPS) 2016 consensus. Results: CR-POPF developed in 38 patients (24.2%). On multivariate logistic analysis, abdominal fat area (ORs=1.006; P=0.05), main pancreatic duct diameter (ORs=0.72; P=0.0008), diabetes mellitus (ORs=4.8; P=0.0038) and the pathology of non-pancreatic cancer (ORs=6.3; P=0.0002). The risk-model based on these factors classified the high risk group, whose discriminant score was above 0.70. To prevent the development and deterioration of POPF, modified Blumgart method, external stenting of bile and pancreatic secretion and continuous irrigation after POPF were instituted. After 2018, 5 patients out of 60 patients in total was the high-risk group. Among them, 1 patient underwent CR-POPF. No patients experienced Grade C POPF. Conclusions: The risk assessment based on preoperative factors for the prediction of POPF after PD was considered as effective in view of the identification of high risk patients and intervention to them. However, the rate of POPF remains high despite several improvement of perioperative management.