Risk Factors for Development of Clinically Relevant Pancreatic Fistula after Laparoscopic Pancreatoduodenectomy in High-risk Patients According to the ua-FRS

Abstract

Introduction: Updated Alternative Fistula Risk Score (ua-FRS) is the accurate tool to predict clinically relevant postoperative pancreatic fistula (CR-POPF) after laparoscopic pancreatoduodenectomy (LPDE). While the risk factors of development of the CR-POPF are well studied, parameters leading to formation CR-POPF in patients of high-risk group are yet to be defined. Objective: To define the risk factors of development of the CR-POPF in patients of high-risk group according to the ua-FRS. Methods: From 2007 to 2018, 290 LPDEs were performed at single institution. The individual risk scores according ua-FRS were calculated for each patient, and clinical outcomes were evaluated. A high-risk group of CR-POPF formation was identified. Risk factors for CR-POPF were evaluated by univariate and multivariate regression analysis. Results: Out of 290 patients, 110 (38%) were allocated to the high-risk group. CR-POPF rate was 39% in this group, whereas it was 21,2% and 9,2% in the whole group and low-risk group, respectively. Univariate analysis revealed that the performing the procedure by the lowest-experienced surgeon and the diagnosis other than pancreatic adenocarcinoma were independent risk factors for CR-POPF formation. The multivariate regression analysis revealed, that Charlson comorbidity index (CCI) higher than 3 is associated with CR-POPF (OR = 2,205, CI 95%, -0,026-0,436). Conclusion: Performing the LPDE by the low-experienced surgeon, diagnosis other than pancreatic adenocarcinoma, CCI higher than 3 are associated with CR-POPF development after LPDE in high-risk patient group.