scholarly journals The prognostic value of external vs internal pancreatic duct stents after pancreaticoduodenectomy in patients with FRS ≥ 4: a retrospective cohort study

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yuancong Jiang ◽  
Qin Chen ◽  
Yi Shao ◽  
Zhenzhen Gao ◽  
Ming Jin ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Pancreatic Duct ◽  
Risk Score ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Postoperative Pancreatic Fistula ◽  
Stent Group ◽  
Operating Characteristic Curve ◽  
Internal Stent ◽  
Fistula Risk Score

Abstract Background The prognostic value of external vs internal pancreatic duct stents after pancreaticoduodenectomy remains controversial. This study aimed to evaluate the benefits of external and internal stents using the Fistula Risk Score system with regard to the incidence of clinically relevant postoperative pancreatic fistula. Methods A total of 382 patients who underwent pancreaticoduodenectomy with duct to mucosa pancreaticojejunostomy were retrospectively enrolled from January 2015 to October 2019. The receiver operating characteristic curve was performed for subgroup analysis of the patients at different levels of risk for pancreatic fistula. Results There were no significant differences in terms of pancreatic fistula or other postoperative complications. According to the receiver operating characteristic curve threshold of 3.5, 172 patients with a Fistula Risk Score ≥ 4 and 210 patients with a Fistula Risk Score < 4 were divided into separate groups. The number of valid cases was insufficient to support the subsequent research in patients with a Fistula Risk Score < 4. In patients with a Fistula Risk Score ≥ 4, the use of an external pancreatic duct stent was significantly more effective than the use of an internal stent, especially with regard to the risk for pancreatic fistula (Grade C) (P = 0.039), at ameliorating the incidence of clinically relevant postoperative pancreatic fistula (P = 0.019). Additionally, the incidence of lymphatic leakage was significantly higher in the external stent group compared with the internal stent group (P = 0.040). Conclusions Compared with internal stents, the use of an external stent could reduce the incidence of clinically relevant postoperative pancreatic fistula in patients with a Fistula Risk Score ≥ 4. More large-scale prospective clinical trials are warranted to further clarify our results.

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 A Probabilistic Model for Cushing’s Syndrome Screening in At-Risk Populations: A Prospective Multicenter Study

2016 ◽  
Vol 101 (10) ◽  
pp. 3747-3754 ◽  
Author(s):  
Antonio León-Justel ◽  
Ainara Madrazo-Atutxa ◽  
Ana I. Alvarez-Rios ◽  
Rocio Infantes-Fontán ◽  
Juan A. Garcia-Arnés ◽  
...  
Keyword(s):  
At Risk ◽  
Receiver Operating Characteristic Curve ◽  
Receiver Operating Characteristic ◽  
Risk Score ◽  
Scoring System ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Clinical Signs ◽  
At Risk Populations ◽  
Operating Characteristic Curve

Context: Cushing’s syndrome (CS) is challenging to diagnose. Increased prevalence of CS in specific patient populations has been reported, but routine screening for CS remains questionable. To decrease the diagnostic delay and improve disease outcomes, simple new screening methods for CS in at-risk populations are needed. Objective: To develop and validate a simple scoring system to predict CS based on clinical signs and an easy-to-use biochemical test. Design: Observational, prospective, multicenter. Setting: Referral hospital. Patients: A cohort of 353 patients attending endocrinology units for outpatient visits. Interventions: All patients were evaluated with late-night salivary cortisol (LNSC) and a low-dose dexamethasone suppression test for CS. Main Outcome Measures: Diagnosis or exclusion of CS. Results: Twenty-six cases of CS were diagnosed in the cohort. A risk scoring system was developed by logistic regression analysis, and cutoff values were derived from a receiver operating characteristic curve. This risk score included clinical signs and symptoms (muscular atrophy, osteoporosis, and dorsocervical fat pad) and LNSC levels. The estimated area under the receiver operating characteristic curve was 0.93, with a sensitivity of 96.2% and specificity of 82.9%. Conclusions: We developed a risk score to predict CS in an at-risk population. This score may help to identify at-risk patients in non-endocrinological settings such as primary care, but external validation is warranted.

scholarly journals Fistula Risk Score-Adjusted Comparison of Postoperative Pancreatic Fistula between Laparoscopic versus Open Pancreatoduodenectomy

HPB ◽  
2019 ◽  
Vol 21 ◽  
pp. S265
Author(s):  
Boram Lee ◽  
Yoo-Seok Yoon ◽  
Chang Moo Kang ◽  
Ho Kyoung Hwang ◽  
Ho-Seong Han ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Risk Score ◽  
Postoperative Pancreatic Fistula ◽  
Fistula Risk Score

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.

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