A Preoperative Predictive Scoring System for Postoperative Pancreatic Fistula after Pancreaticoduodenectomy

• Published in: World journal of surgery 2011-12, Vol.35 (12), p.2747-2755
• Main Authors: Yamamoto, Yusuke, Sakamoto, Yoshihiro, Nara, Satoshi, Esaki, Minoru, Shimada, Kazuaki, Kosuge, Tomoo
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Aged; Biological and medical sciences; Cardiac Surgery; Female; General aspects; General Surgery; Humans; Main Pancreatic Duct; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Pancreatic Cancer; Pancreatic Fistula - diagnosis; Pancreatic Fistula - etiology; Pancreaticoduodenectomy - adverse effects; Portal Vein; Predictive Value of Tests; Receiver Operating Characteristic Curve; Risk Assessment; Stomach, duodenum, intestine, rectum, anus; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Thoracic Surgery; Validation Group; Vascular Surgery
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-011-1253-x

Background Postoperative pancreatic fistula (POPF) remains a leading cause of morbidity after pancreaticoduodenectomy (PD). In the present study we sought to establish a preoperative scoring system with which to predict this complication. Patients and methods The clinical records of 387 consecutive patients who underwent PD for periampullary tumor between 2004 and 2009 were reviewed retrospectively. Patients were divided into two groups; 279 consecutive patients constituted the study group and the next 108 patients constituted the validation group. Univariate and multivariate logistic regression analyses were performed using preoperative and surgical factors potentially influencing grade B or C POPF in the study group, and a score to predict POPF was constructed. This score was confirmed in the validation group. Results In the study group, grade A POPF was recognized in 45 patients (16%), grade B in 98 (35%), and grade C in 5 (2%). A preoperative predictive scoring system for POPF (0-7 points) was constructed using the following 5 factors; main pancreatic duct index 65 mm (1 point). The nomogram showed an area under the curve (AUC) of 0.808. This scoring system was highly predictive for grade B or C POPF in the validation group (AUC = 0.834). Conclusions The present scoring system satisfactorily predicted the occurrence of POPF and thus will be useful for the perioperative risk management of patients undergoing PD in a high-volume center hospital.