Modified prediction system using combined preoperative anthropomorphic imbalance and fistula risk score for predicting clinically relevant postoperative pancreatic fistula after pancreaticoduodenectomy
Abstract Background This study aimed to evaluate the efficacy of the combination of fistula risk score (FRS) and preoperative body composition factors for predicting the occurrence of clinically relevant postoperative pancreatic fistula (CR-POPF) after pancreaticoduodenectomy (PD). Methods In this study, 136 consecutive patients who underwent PD between 2006 and 2018 were enrolled. The risk factors of CR-POPF (grades B and C) were analyzed. Preoperative visceral adipose tissue area (VATA), skeletal mass index (SMI), and subcutaneous adipose tissue area (SATA) were calculated from computed tomography data. Results The overall 30-day mortality and morbidity rates were 0.7% and 38%, respectively. The incidence of grade B and C CR-POPF was 27% and 4%, respectively. Univariate analysis revealed that male sex, habitual smoking, prognostic nutritional index (PNI) < 45, VATA ≥ 90, VATA/SATA ≥ 0.9, VATA/SMI ≥ 1.4, and FRS > 4 were significantly associated with the incidence of CR-POPF. Multivariate analysis revealed that PNI < 45, VATA/SMI ≥ 1.4, and FRS > 4 were the independent risk factors of CR-POPF. A modified prediction score using the combination of VATA/SMI and FRS significantly predicted CR-POPF after PD. Conclusions Preoperative anthropomorphic imbalance and FRS were equally accurate in predicting CR-POPF. Patients with high-risk factors should be closely monitored during the postoperative period.