scholarly journals Predicting postoperative pancreatic fistula in pancreatic head resections: which score fits all?

2021 ◽  
Author(s):  
Mariam Adamu ◽  
Verena Plodeck ◽  
Claudia Adam ◽  
Anne Roehnert ◽  
Thilo Welsch ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Risk Score ◽  
Pancreatic Head ◽  
Major Complication ◽  
Risk Groups ◽  
Postoperative Pancreatic Fistula ◽  
Prognostic Scores ◽  
Risk Scores ◽  
Reactive Protein ◽  
Prognostic Stratification

Abstract Purpose Postoperative 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. Methods A 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. Results Nine 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. Conclusion Most 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.

scholarly journals Retrospective Comparative Analysis of POPF Using Fistula Risk Score According to Pancreaticoenterostomy Method

2021 ◽  
Vol 105 (1-3) ◽  
pp. 559-563
Author(s):  
Seungmin Lee ◽  
Kwang Yeol Paik
Keyword(s):  
High Risk ◽  
Pancreatic Fistula ◽  
Risk Score ◽  
Risk Group ◽  
Risk Groups ◽  
High Risk Group ◽  
Postoperative Pancreatic Fistula ◽  
Clinical Risk Score ◽  
Reconstructive Methods ◽  
Fistula Risk Score

Background The aim of this study is to examine whether pancreaticogastrostomy (PG) or pancreaticojejunostomy (PJ) is the better reconstructive method to reduce postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD) according to the fistula risk. Methods An institutional database was reviewed for patients undergoing PD between January 2008 and August 2019. A total of 159 patients were stratified into 4 groups according to the Clinical Risk Score-Pancreatic Fistula. POPF according to 4 risk groups was compared between PJ and PG. Results Of the 159 patients, 82 underwent PG (51.6%) and 77 underwent PJ (48.4%) reconstruction. POPF rate was 17.1% (n = 14) in the PG group and 12.9% (n = 10) in the PJ group (P = 0.51). POPF rates were not different in intermediate, low, and negligible risks between 2 reconstructive methods. In the high-risk group (n = 47), there were 4 POPFs (22.2%) in PJ group and 9 (31.0%) in the PG group, respectively (P = 0.74). Conclusion In PD, there was no superior method of reconstruction with regard to POPF, even in high-risk glands.

scholarly journals O-P06 Early postoperative differentiation between biochemical leak and clinically-relevant pancreatic fistula after pancreaticoduodenectomy: development of a predictive risk score

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Syed Soulat Raza ◽  
Anisa Nutu ◽  
Sarah Powell-Brett ◽  
Amanda Carvalheiro Boteon ◽  
James Hodson ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Risk Score ◽  
Multivariable Analysis ◽  
Length Of Hospital Stay ◽  
Binary Logistic Regression ◽  
Early Postoperative Period ◽  
Risk Scores ◽  
Binary Logistic Regression Model ◽  
Reactive Protein ◽  
Predictive Risk

Abstract Background Several risk scores are available which predict pancreatic fistula after pancreaticoduodenectomy (PD), but do not differentiate between biochemical leak (BL) and clinically relevant pancreatic fistula (CR-POPF). The aim of this study was to identify factors that differentiate between BL and CR-POPF in the early postoperative period. Methods Consecutive patients diagnosed with BL and CR-POPF after PD were identified from a prospectively maintained database (2009-2019). Data were collected for demographics, intraoperative and laboratory parameters on the first five postoperative days (PODs), including drain fluid amylase (DFA), C-reactive protein (CRP) and albumin. Independent predictors of CR-POPF were identified using a multivariable binary logistic regression model, which was subsequently converted to a risk score Results 187 patients consisted of 99 BL and 88 CR-POPF. In those with CR-POPF, the leak became clinically relevant a median of 9 days after surgery; these patients had a significantly higher length of hospital stay than those with BL (median: 24 vs. 10 days, p &lt; 0.001). On multivariable analysis, male gender (p = 0.002), higher DFA (p &lt; 0.001) or CRP (p &lt; 0.001) on POD3, lower albumin (p = 0.028) on POD3 were all found to be independent predictors of CR-POPF. A risk score based on these factors returned an area under the ROC curve of 0.78. Conclusions In patients with a confirmed pancreatic fistula it may be possible to differentiate between BL and CR-POPF using early postoperative variables, particularly DFA, serum albumin and CRP. Early identification of CR-POPF may allow earlier intervention to improve clinical outcomes.

scholarly journals O-P01 Potential Utility of Intraoperative Fluid Amylase Measurement During Pancreaticoduodenectomy

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
K Joshi ◽  
M Abradelo ◽  
N Chatzizacharias ◽  
D Bartlett ◽  
B Dasari ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Risk Score ◽  
Postoperative Pancreatic Fistula ◽  
Low Risk ◽  
Risk Scores ◽  
Pancreatic Anastomosis ◽  
Patient Demographics ◽  
Clinical Risk ◽  
Risk Patients ◽  
Fistula Risk Score

Abstract Background Postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD) is a source of major morbidity and mortality. Early diagnosis and treatment of POPF is mandatory to improve patient outcomes, and clinical risk scores may be combined with postoperative drain fluid amylase (DFA) values to stratify patients. The aim of this study was to determine if intraoperative fluid amylase values (IFA) correlate with DFA1 and POPF. Methods In consecutive patients undergoing PD between February and November 2020, intraoperative samples of intra-abdominal fluid adjacent to the pancreatic anastomosis were taken and sent for fluid amylase measurement prior to abdominal closure. Data regarding patient demographics, postoperative DFA values, complications and mortality were prospectively collected. Results Patient Demographics: Data was obtained for 52 patients with a median alternative Fistula Risk Score (aFRS) of 9.4. Postoperative complications occurred in 20 patients (38%), including five Clavien grade 3+. There were eight POPFs and two patients died (pneumonia/sepsis). There was significant correlation between IFA and DFA1 (Pearson’s correlation: R2=0.713; p &lt; 0.001) and DFA3 (p &lt; 0.001), and median IFA was higher in patients with POPF than patients without (1232.5 vs. 122; p = 0.0003). IFA&gt;260 U/l predicted POPF with sensitivity, specificity, PPV and NPV of 88%, 75%, 39% and 97%, respectively. The incidence of POPF was 43% in high risk (high aFRS/IFA) and 0% in low risk patients (low aFRS/IFA). Complications: Conclusions Intraoperative fluid amylase closely correlated with postoperative pancreatic fistula, and may be a useful adjunct to clinical risk scores to stratify patients during pancreatico-duodenectomy, allowing targeted intervention to reduce the clinical impact of pancreatic fistula.It is possible to detect fluid amylase adjacent to the completed pancreatic anastomosis in patients undergoing PD. Presence of IFA correlates with postoperative DFA and POPF. IFA increases the accuracy of the alternate Fistula Risk Score in predicting POPF. Low risk patients with a low IFA may be suitable for a ‘no drain’ strategy, whilst patients with a high IFA may benefit from intraoperative mitigation strategies to reduce the incidence and/or severity of a postoperative pancreatic fistula.

scholarly journals Matched Analysis of Postoperative Pancreatic Fistula Using Fistula Risk Score According to Pancreaticoenterostomy Methods

2020 ◽  
Author(s):  
Seungmin Lee ◽  
Kwang Yeol Paik ◽  
Ji Seon Oh ◽  
Eung Kook Kim
Keyword(s):  
High Risk ◽  
Pancreatic Fistula ◽  
Risk Score ◽  
Risk Group ◽  
Risk Groups ◽  
High Risk Group ◽  
Postoperative Pancreatic Fistula ◽  
Clinical Risk Score ◽  
Reconstructive Methods ◽  
Fistula Risk Score

Abstract Background To examine whether pancreaticogastrostomy (PG) or pancreaticojejunostomy (PJ) is the better reconstructive method to reduce Postoperative Pancreatic Fistula (POPF), after pancreaticoduodenectomy (PD) according to the fistula risk. Methods An institutional database was reviewed for patients undergoing PD between January 2008 and August 2019. 159 patients were stratified into four groups according to the Clinical Risk Score-Pancreatic Fistula (CRS-PF). POPF according to 4 risk groups was compared between PJ and PG. Results Of the 159 patients, 82 underwent PG (51.6%) and 77 underwent PJ (48.4%) reconstruction. POPF rate was 15.1% and 17.1% (n=14) in the PG group and 12.9% (n=10) in the PJ group (P =0.51). POPF rates were not different in intermediate, low and negligible risks between two reconstructive methods. In High risk group (n=47), there was 4 (22.2%) POPF in PJ group and 9 (31.0%) in PG group, respectively (p=0.74). Conclusions In PD, there was no superior method of reconstruction with regards of POPF, even in high risk glands.

scholarly journals Predictive Significance of C-reactive Protein-to-albumin Ratio for Postoperative Pancreatic Fistula After Pancreaticoduodenectomy

2019 ◽  
Vol 39 (11) ◽  
pp. 6283-6290 ◽  
Author(s):  
TERUHISA SAKAMOTO ◽  
YAKUKI YAGYU ◽  
EI UCHINAKA ◽  
MASAKI MORIMOTO ◽  
TAKEHIKO HANAKI ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Postoperative Pancreatic Fistula ◽  
C Reactive Protein ◽  
Albumin Ratio ◽  
Reactive Protein

scholarly journals Dynamic prediction for clinically relevant pancreatic fistula: a novel prediction model for laparoscopic pancreaticoduodenectomy

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Runwen Liu ◽  
Yunqiang Cai ◽  
He Cai ◽  
Yajia Lan ◽  
Lingwei Meng ◽  
...  
Keyword(s):  
Prediction Model ◽  
Pancreatic Fistula ◽  
Postoperative Pancreatic Fistula ◽  
Laparoscopic Pancreaticoduodenectomy ◽  
C Reactive Protein ◽  
Dynamic Prediction ◽  
Albumin Ratio ◽  
Drainage Fluid ◽  
Reactive Protein ◽  
Baseline Factors

Abstract Background With the recent emerge of dynamic prediction model on the use of diabetes, cardiovascular diseases and renal failure, and its advantage of providing timely predicted results according to the fluctuation of the condition of the patients, we aim to develop a dynamic prediction model with its corresponding risk assessment chart for clinically relevant postoperative pancreatic fistula after laparoscopic pancreaticoduodenectomy by combining baseline factors and postoperative time-relevant drainage fluid amylase level and C-reactive protein-to-albumin ratio. Methods We collected data of 251 patients undergoing LPD at West China Hospital of Sichuan University from January 2016 to April 2019. We extracted preoperative and intraoperative baseline factors and time-window of postoperative drainage fluid amylase and C-reactive protein-to-albumin ratio relevant to clinically relevant pancreatic fistula by performing univariate and multivariate analyses, developing a time-relevant logistic model with the evaluation of its discrimination ability. We also established a risk assessment chart in each time-point. Results The proportion of the patients who developed clinically relevant postoperative pancreatic fistula after laparoscopic pancreaticoduodenectomy was 7.6% (19/251); preoperative albumin and creatine levels, as well as drainage fluid amylase and C-reactive protein-to-albumin ratio on postoperative days 2, 3, and 5, were the independent risk factors for clinically relevant postoperative pancreatic fistula. The cut-off points of the prediction value of each time-relevant logistic model were 14.0% (sensitivity: 81.9%, specificity: 86.5%), 8.3% (sensitivity: 85.7%, specificity: 79.1%), and 7.4% (sensitivity: 76.9%, specificity: 85.9%) on postoperative days 2, 3, and 5, respectively, the area under the receiver operating characteristic curve was 0.866 (95% CI 0.737–0.996), 0.896 (95% CI 0.814–0.978), and 0.888 (95% CI 0.806–0.971), respectively. Conclusions The dynamic prediction model for clinically relevant postoperative pancreatic fistula has a good to very good discriminative ability and predictive accuracy. Patients whose predictive values were above 14.0%, 8.3%, and 7.5% on postoperative days 2, 3, and 5 would be very likely to develop clinically relevant postoperative pancreatic fistula after laparoscopic pancreaticoduodenectomy.

scholarly journals The modified Blumgart anastomosis after pancreaticoduodenectomy: a retrospective single center cohort study

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Georgi Kalev ◽  
Christoph Marquardt ◽  
Herbert Matzke ◽  
Paul Matovu ◽  
Thomas Schiedeck
Keyword(s):  
Length Of Stay ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Pancreatic Fistula ◽  
Pancreatic Head ◽  
Suture Technique ◽  
Postoperative Pancreatic Fistula ◽  
Intermediate Care ◽  
Pancreatic Head Resection ◽  
Pancreatic Anastomosis

AbstractObjectivesThe postoperative pancreatic fistula (POPF) is a major complication after pancreatic head resection whereby the technique of the anastomosis is a very influencing factor. The literature describes a possible protective role of the Blumgart anastomosis.MethodsPatients after pancreatic head resection with reconstruction through the modified Blumgart anastomosis (a 2 row pancreatic anastomosis through mattress sutures of the parenchyma and duct to mucosa pancreaticojejunostomy, Blumgart-group) were compared with patients after pancreatic head resection and reconstruction through the conventional pancreatojejunostomy (single suture technique of capsule and parenchyma to seromuscularis, PJ-group). The Data were collected retrospectively. Depending on the propensity score matching in a ratio of 1:2 comparison groups were set up. Blumgart-group (n=29) and PJ-group (n=56). The primary end point was the rate of POPF. Secondary goals were duration of operation, length of hospital stay, length of stay on intermediate care units and hospital mortality.ResultsThe rate of POPF (biochemical leak, POPF “grade B” and POPF “grade C”) was less in the Blumgart-group, but without statistical relevance (p=0.23). Significantly less was the rate of POPF “grade C” in the Blumgart-group (p=0.03). Regarding the duration of hospital stay, length of stay on intermediate care units and hospital mortality, there was no relevant statistical difference between the groups (p=0.1; p=0.4; p=0.7). The duration of the operation was significantly less in the Blumgart-group (p=0.001).ConclusionsThe modified Blumgart anastomosis technique may have the potential to decrease major postoperative pancreatic fistula.

scholarly journals Comparison of surgical outcomes between isolated pancreaticojejunostomy, isolated gastrojejunostomy, and conventional pancreaticojejunostomy after pancreaticoduodenectomy: A systematic review and meta-analysis

2020 ◽  
Author(s):  
lyu yunxiao ◽  
Bin Wang ◽  
Yunxiao Cheng ◽  
Yueming Xu ◽  
WeiBing Du
Keyword(s):  
Gastric Emptying ◽  
Pancreatic Fistula ◽  
Delayed Gastric Emptying ◽  
Operation Time ◽  
Major Complication ◽  
Bile Leakage ◽  
Postoperative Pancreatic Fistula ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Major Complications

Abstract Background We aimed to compare the safety and effectiveness of the following procedures after pancreaticoduodenectomy: isolated pancreaticojejunostomy, isolated gastrojejunostomy, and conventional pancreaticojejunostomy. Methods We performed a systematic search of the following databases: PubMed, Embase, Web of Science, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov until 1 January 2020. Pooled odds ratios (OR) or weighted mean differences (WMD) with 95% confidence intervals (CIs) were calculated using STATA 12.0 statistical software.Results Thirteen studies involving 1942 patients were included in this study. Pooled analysis showed that the major complication and reoperation rates following isolated pancreaticojejunostomy were lower than with conventional pancreaticojejunostomy (OR=0.35, 95% CI: 0.13–0.96, P=0.04 and OR=0.36, 95% CI: 0.15–0.86, p=0.02, respectively), and that isolated pancreaticojejunostomy required longer operation time vs conventional pancreaticojejunostomy (WMD=43.61, 95% CI: 21.64–65.58, P=0.00). Regarding postoperative pancreatic fistula, clinically-relevant postoperative pancreatic fistula, delayed gastric emptying, clinically-relevant delayed gastric emptying, bile leakage, hemorrhage , reoperation, length of postoperative hospital stay, major complications, overall complications, and mortality, we found no significant differences for either isolated pancreaticojejunostomy versus conventional pancreaticojejunostomy or isolated gastrojejunostomy versus conventional pancreaticojejunostomy. Conclusions This study showed that isolated pancreaticojejunostomy was associated with fewer major complications and a lower reoperation rate, but required longer operation time vs conventional pancreaticojejunostomy. Considering the limitations, high-quality randomized controlled trials are required.

scholarly journals Limited Utility of Cardiovascular Risk Scores for People Living with HIV in Malawi

2020 ◽  
Author(s):  
Chia Goh ◽  
Henry Mwandumba ◽  
Alicja Rapala ◽  
Willard Tingao ◽  
Irene Sheha ◽  
...  
Keyword(s):  
Risk Score ◽  
Low Income ◽  
Intima Media Thickness ◽  
Risk Groups ◽  
Carotid Intima Media Thickness ◽  
Endothelial Damage ◽  
Risk Scores ◽  
People Living With Hiv ◽  
Cvd Risk ◽  
Living With Hiv

HIV is associated with increased cardiovascular disease (CVD) risk. Despite the high prevalence of HIV in low income subSaharan Africa, there are few data on the assessment of CVD risk in the region. In this study, we aimed to compare the utility of existing CVD risk scores in a cohort of Malawian adults, and assess to what extent they correlate with established markers of endothelial damage: carotid intima media thickness (IMT) and pulse wave velocity (PWV). WHO/ISH, SCORE, FRS, ASCVD, QRISK2 and D:A:D scores were calculated for 279 Malawian adults presenting with HIV and low CD4. Correlation of the calculated 10year CVD risk score with IMT and PWV was assessed using Spearmans rho. The median (IQR) age of patients was 37 (31 to 43) years and 122 (44%) were female. Median (IQR) blood pressure was 120/73mmHg (108/68 to 128/80) and 88 (32%) study participants had a new diagnosis of hypertension. The FRS and QRISK2 scores included the largest number of participants in this cohort (96% and 100% respectively). D:A:D, a risk score specific for people living with HIV, identified more patients in moderate and high risk groups. Although all scores correlated well with physiological markers of endothelial damage, FRS and QRISK2 correlated most closely with both IMT [r2 0.51, p<0.0001 and r2 0.47, p<0.0001 respectively] and PWV [r2 0.47, p<0.0001 and r2 0.5, p<0.0001 respectively]. Larger cohort studies are required to adapt and validate risk prediction scores in this region, so that limited healthcare resources can be effectively targeted.

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