Abstract

PurposePostoperative pancreatic fistula (POPF) is a major complication of pancreatic surgery and can be fatal. Better stratification of patients into risk groups may help to select those who might benefit from strategies to prevent complications. The aim of this study was to validate ten prognostic scores in patients who underwent pancreatic head surgery.MethodsA total of 364 patients were included in this study between September 2012 and August 2017. Ten risk scores were applied to this cohort. Univariate and multivariate analyses were performed considering all risk factors in the scores. Furthermore, the stratification of patients into risk categories was statistically tested.ResultsNine of the scores (Ansorge et al., Braga et al., Callery et al., Graham et al., Kantor et al., Mungroop et al., Roberts et al., Yamamoto et al. and Wellner et al.) showed strong prognostic stratification for developing POPF (p < 0.001). There was no significant prognostic value for the Fujiwara et al. risk score. Histology, pancreatic duct diameter, intraabdominal fat thickness in computed tomography findings, body mass index, and C-reactive protein were independent prognostic factors on multivariate analysis.ConclusionMost risk scores tend to stratify patients correctly according to risk for POPF. Nevertheless, except for the fistula risk score (Callery et al.) and its alternative version (Mungroop et al.), many of the published risk scores are obscure even for the dedicated pancreatic surgeon in terms of their clinical practicability. There is a need for future studies to provide strategies for preventing POPF and managing patients with high-risk stigmata.

Highlights

  • Postoperative pancreatic fistula (POPF) [1] is a major complication of pancreatic surgery

  • Pancreatic fistulas are classified as biochemical leak, and grades B and C POPF according to the International Study Group of Pancreatic Surgery [11]

  • Patients who underwent either laparoscopic or conventional pyloruspreserving pancreaticoduodenectomy (PPPD), duodenumpreserving pancreatic head resection (DPPHR), or the Whipple procedure for chronic pancreatitis or benign or malignant lesions from September 2012 to August 2017 were prospectively enrolled in the study and their data included in a database

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Summary

Introduction

Postoperative pancreatic fistula (POPF) [1] is a major complication of pancreatic surgery. Pain and sepsis are the main morbidity elements of POPF, mortality can occur due to serious adverse events like postpancreatectomy hemorrhage (PPH) [3]. The incidence of POPF has been shown to reach up to more than 30% [4, 5, 8,9,10] in a number of studies, even in high-volume pancreas centers. The management of patients in these high-volume centers plays a key role in the associated reduced mortality. Pancreatic fistulas are classified as biochemical leak, and grades B and C POPF according to the International Study Group of Pancreatic Surgery [11].

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