scholarly journals Assessment of preoperative clinicophysiological findings as risk factors for postoperative pancreatic fistula after pancreaticoduodenectomy

2021 ◽  
Author(s):  
Shuji Suzuki ◽  
Mitsugi Shimoda ◽  
Jiro Shimazaki ◽  
Yukio Oshiro ◽  
Kiyotaka Nishida ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pancreatic Fistula ◽  
Univariate Analysis ◽  
Prognostic Nutritional Index ◽  
Postoperative Pancreatic Fistula ◽  
Reactive Protein ◽  
Independent Risk Factors ◽  
Hospital Morbidity ◽  
Group B ◽  
Medical University

Objective Postoperative pancreatic fistula (POPF) is one of the severe complications that develop after pancreaticoduodenectomy (PD). This study aimed to assess the utility of preoperative clinicophysiological findings as risk factors for POPF after PD. Summary of Background Data We enrolled 350 patients who underwent PD between 2007 and 2012 at Tokyo Women’s Medical University. Methods In total, 350 patients who underwent PD between 2007 and 2012 were examined retrospectively. All patients were classified into two groups as follows: group A (no fistula/ biochemical leak group, 289 patients) and group B (grade B/C of POPF group 61 patients). Variables, including operative characteristics, length of stay in hospital, morbidity, mortality, and data regarding preoperative clinicophysiological parameters were collected and analyzed as predictors of POPF for univariate and multivariate analyses. Results There were 213 male and 137 female patients. The mean age was 65.4 years (range: 21-87years). Univariate analysis showed that sex (p=0.047), amylase (p=0.032), prognostic nutritional index (PNI) (p=0.001), C-reactive protein/Albumin ratio (p=0.005) were independent risk factors for POPF. In contrast, multivariate analysis showed that sex (p=0.045) and PNI (p=0.012) were independent risk factors for POPF. Conclusions Our results show that PNI (≤48.64 U/mL) and male sex were risk factors for POPF after PD, and especially, PNI can be suggested as an effective biomarker for POPF.

scholarly journals Comprehensive Diagnostic Nomogram for Predicting Clinically Relevant Postoperative Pancreatic Fistula After Pancreatoduodenectomy

2021 ◽  
Vol 11 ◽  
Author(s):  
Bo Li ◽  
Ning Pu ◽  
Qiangda Chen ◽  
Yong Mei ◽  
Dansong Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pancreatic Fistula ◽  
Predictive Value ◽  
Predictive Accuracy ◽  
Postoperative Pancreatic Fistula ◽  
Diagnostic Model ◽  
Discriminative Ability ◽  
Reactive Protein ◽  
Independent Risk Factors ◽  
Drain Amylase

BackgroundClinically relevant postoperative pancreatic fistula (CR-POPF) remains a severe and challenging complication of pancreaticoduodenectomy (PD). This study aimed to establish a novel postoperative nomogram-based diagnostic model for the early detection of CR-POPF in patients subjected to PD.MethodsConsecutive patients who underwent PD in Zhongshan Hospital, Fudan University from December 2018 to October 2020 were retrospectively enrolled. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for CR-POPF. Then, a novel predictive nomogram was established accordingly.ResultsAmong the consecutive 176 patients who underwent PD, 37 (21.1%) patients developed CR-POPF. Through univariate and multivariate analyses, the drain amylase (P = 0.002), serum creatinine (P = 0.009), and serum C reactive protein (P = 0.045) at postoperative day 1 (POD1) as well as the neutrophil count (P = 0.025) and temperature (P = 0.025) at POD3 were identified as independent risk factors for CR-POPF. Based on this, a novel predictive nomogram containing these factors was constructed to predict the probability of CR-POPF after PD. The formulated nomogram showed better performance to detect CR-POPF after PD with a sensitivity of 0.784, specificity of 0.770, positive predictive value of 0.475, and negative predictive value of 0.930 when compared to other predictors. In addition, the predictive value of the nomogram was assessed by a concordance index of 0.814 (95% CI, 0.736–0.892), which was significantly higher than indicators alone. This was further validated and depicted by decision curve analysis and clinical impact curve.ConclusionThis study established a diagnostic nomogram of postoperative objective parameters that can predict the development of CR-POPF after PD with a good discriminative ability and predictive accuracy.

scholarly journals Intraoperative pancreatic injury gives rise to severe postoperative pancreatic fistula: Results of a review of unedited videos of the laparoscopic surgical procedures

2018 ◽  
Author(s):  
Yuya Sato ◽  
Kazuyuki Kojima ◽  
Mikito Inokuchi ◽  
Keiji Kato ◽  
Hirofumi Sugita ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pancreatic Fistula ◽  
Surgical Procedures ◽  
Univariate Analysis ◽  
Significant Risk ◽  
Pancreatic Injury ◽  
Postoperative Pancreatic Fistula ◽  
Video Recordings ◽  
Significant Difference ◽  
Laparoscopic Surgical Procedures

Objective To examine risk factors for and causes of severe postoperative pancreatic fistula (sPOPF) after laparoscopic gastrectomy (LG) Summary of Background Data There are few reports on POPF after LG. Methods Between February 2012 and March 2014, we examined 86 patients who underwent LG comparing them with 33 patients who underwent open gastrectomy (OG) for gastric cancer. Risk factors for severe POPF (sPOPF) of Clavien-Dindo grade IIIa or higher were examined. To investigate causes of sPOPF, we reviewed unedited video recordings of laparoscopic surgical procedures. Results sPOPF occurred to 3 patients (3.5%) after LG and 1 patient (3.0%) after OG, indicating no significant difference (p=0.901). Univariate analysis showed no significant risk factors for sPOPF after LG. By reviewing video recordings, all 3 patients with sPOPF after LG had direct pancreatic injury by ultrasonically activated device (USAD) during peripancreatic lymphadenectomy. In 2 of them, pancreas was injured while the contour of pancreas was obscured by bleeding. Durations of drain placement and postoperative hospitalization were longer for patients with sPOPF than for those without POPF or grades I and II POPF (p = 0.003, 0.018; respectively). Conclusions No risk factors for sPOPF after LG could be identified. USAD-induced direct pancreatic injury resulted in sPOPF, which significantly complicated the postoperative clinical course. Direct pancreatic injury can occur whether patient has previously reported risk factors (i.e. male, high BMI, distal pancreatectomy) or not. To prevent pancreatic injury, surgeons should manage hemostasis and keep good surgical field to recognize the contour of pancreas accurately.

scholarly journals Preoperative CT anthropometric measurements and pancreatic pathology increase risk for postoperative pancreatic fistula in patients following pancreaticoduodenectomy

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0243515
Author(s):  
Yun Hwa Roh ◽  
Bo Kyeong Kang ◽  
Soon-Young Song ◽  
Chul-Min Lee ◽  
Yun Kyung Jung ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pancreatic Fistula ◽  
International Study ◽  
Multivariate Regression Analysis ◽  
Postoperative Pancreatic Fistula ◽  
Increase Risk ◽  
Preoperative Ct ◽  
Independent Risk Factors ◽  
Definition Of ◽  
Pancreatic Pathology

Postoperative pancreatic fistula (POPF) is a common complication following pancreaticoduodenectomy (PD). However, risk factors for this complication remain controversial. We conducted a retrospective analysis of 107 patients who underwent PD. POPF was diagnosed in strict accordance with the definition of the 2016 update of pancreatic fistula from the International Study Group on Pancreatic Fistula (ISGPF). Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for POPF. A total of 19 (17.8%) subjects of pancreatic fistula occurred after PD, including 15 (14.1%) with grade B POPF and 4 (3.7%) with grade C POPF. There were 33 (30.8%) patients with biochemical leak. Risk factors for POPF (grade B and C) were larger area of visceral fat (odds ratio [OR], 1.40; p = 0.040) and pathology other than pancreatic adenocarcinoma or pancreatitis (OR, 12.45; p = 0.017) in the multivariate regression analysis. This result could assist the surgeon to identify patients at a high risk of developing POPF.

Histomorphological Features of the Pancreatic Remnant as Independent Risk Factors for Postoperative Pancreatic Fistula: A Matched-Pairs Analysis

Pancreatology ◽  
2011 ◽  
Vol 11 (5) ◽  
pp. 516-524 ◽  
Author(s):  
Orlin Belyaev ◽  
Johanna Munding ◽  
Torsten Herzog ◽  
Dominique Suelberg ◽  
Andrea Tannapfel ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pancreatic Fistula ◽  
Postoperative Pancreatic Fistula ◽  
Matched Pairs ◽  
Pancreatic Remnant ◽  
Independent Risk Factors

scholarly journals Modified prediction system using combined preoperative anthropomorphic imbalance and fistula risk score for predicting clinically relevant postoperative pancreatic fistula after pancreaticoduodenectomy

2020 ◽  
Author(s):  
Tomoyuki Abe ◽  
Hironobu Amano ◽  
Tsuyoshi Kobayashi ◽  
Keiji Hanada ◽  
Minoru Hattori ◽  
...  
Keyword(s):  
Risk Factors ◽  
Adipose Tissue ◽  
Pancreatic Fistula ◽  
Risk Score ◽  
Univariate Analysis ◽  
Postoperative Pancreatic Fistula ◽  
Mortality And Morbidity ◽  
Skeletal Mass ◽  
Tissue Area ◽  
Fistula Risk Score

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.

Clinical Impact of Preoperative Cholangitis after Biliary Drainage in Patients who Undergo Pancreaticoduodenectomy on Postoperative Pancreatic Fistula

2014 ◽  
Vol 80 (1) ◽  
pp. 36-42 ◽  
Author(s):  
Hiroaki Yanagimoto ◽  
Sohei Satoi ◽  
Tomohisa Yamamoto ◽  
Hideyoshi Toyokawa ◽  
Satoshi Hirooka ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pancreatic Fistula ◽  
Biliary Drainage ◽  
Multivariate Analyses ◽  
Preoperative Biliary Drainage ◽  
Postoperative Pancreatic Fistula ◽  
Prophylactic Antibiotics ◽  
Clinical Background ◽  
Study Population ◽  
Independent Risk Factors

The objective of this study was to examine whether the development of cholangitis after preoperative biliary drainage (PBD) can increase the incidence of postoperative pancreatic fistula (POPF). The study population included 185 consecutive patients who underwent pancreaticoduodenectomy from April 2006 to March 2011. All patients were divided into two groups, which consisted of a “no PBD” group (73 patients) and a PBD group (112 patients). Moreover, the PBD group was divided into a “cholangitis” group (21 patients) and a “no cholangitis” group (91 patients). Clinical background, clinical outcome, and postoperative complications were compared between groups. All patients received prophylactic antibiotics using cefmetazole until 1 or 2 days postoperatively. There was no difference between noncholangitis and non-PBD groups except the frequency of overall POPF. Clinically relevant POPF and drain infection occurred in the cholangitis group significantly more than in the noncholangitis group ( P < 0.05). Univariate and multivariate analyses showed that development of preoperative cholangitis after preoperative biliary drainage and small pancreatic duct (less than 3 mm diameter) were independent risk factors for clinically relevant POPF. The frequency of clinically relevant POPF was 8 per cent (eight of 99) in patients without two risk factors, 19 per cent (15 of 80) in patients with one risk factor, and 50 per cent (three of six) in patients with both risk factors. The development of preoperative cholangitis after PBD was closely associated with the development of clinically relevant POPF under the limited use of prophylactic antibiotics.

scholarly journals Risk Factors for Clinically Relevant Postoperative Pancreatic Fistula (CR-POPF) after Distal Pancreatectomy: A Single Center Retrospective Study

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Gao Qing Wang ◽  
Dipesh Kumar Yadav ◽  
Wei Jiang ◽  
Yong Fei Hua ◽  
Cai De Lu
Keyword(s):  
Risk Factors ◽  
Retrospective Study ◽  
Pancreatic Fistula ◽  
Pancreatic Duct ◽  
Distal Pancreatectomy ◽  
Main Pancreatic Duct ◽  
Surgical Complication ◽  
Univariate Analysis ◽  
Postoperative Pancreatic Fistula ◽  
Soft Pancreas

Objectives. Clinically relevant postoperative pancreatic fistula (CR-POPF) is the considerable contributor to major complications after pancreatectomy. The purpose of this study was to evaluate the potential risk factor contributing to CR-POPF following distal pancreatectomy (DP) and discuss the risk factors of pancreatic fistula in order to interpret the clinical importance. Methods. In this retrospective study, 263 patients who underwent DP at Ningbo Medical Center Li Huili Hospital between January 2011 and January 2020 were reviewed in accordance with relevant guidelines and regulations. Patients’ demographics and clinical parameters were evaluated using univariate and multivariate analyses to identify the risk factors contributing to CR-POPF. P < 0.05 was considered statistically significant. Results. In all of the 263 patients with DP, pancreatic fistula was the most common surgical complication (19.0%). The univariate analysis of 18 factors showed that the patients with a malignant tumor, soft pancreas, and patient without ligation of the main pancreatic duct were more likely to develop pancreatic fistula. However, on multivariate analysis, the soft texture of the pancreas (OR = 2.381, 95% CI = 1.271–4.460, P = 0.001 ) and the ligation of the main pancreatic duct (OR = 0.388, 95% CI = 0.207–0.726, P = 0.002 ) were only an independent influencing factor for CR-POPF. Conclusions. As a conclusion, pancreatic fistula was the most common surgical complication after DP. The soft texture of the pancreas and the absence of ligation of the main pancreatic duct can increase the risk of CR-POPF.

scholarly journals Preoperative anthropomorphic and nutritious status and fistula risk score for predicting clinically relevant postoperative pancreatic fistula after pancreaticoduodenectomy

2020 ◽  
Author(s):  
Tomoyuki Abe ◽  
Hironobu Amano ◽  
Tsuyoshi Kobayashi ◽  
Keiji Hanada ◽  
Minoru Hattori ◽  
...  
Keyword(s):  
Risk Factors ◽  
Adipose Tissue ◽  
Pancreatic Fistula ◽  
Risk Score ◽  
Univariate Analysis ◽  
Incidence Rates ◽  
Postoperative Pancreatic Fistula ◽  
Skeletal Mass ◽  
Tissue Area ◽  
Fistula Risk Score

Abstract Background: The aim of this study was 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 rates of grade B and C CR-POPF were 27% and 4%, respectively. A 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. A 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, PNI, and FRS were equally accurate in predicting CR-POPF. Patients with high-risk factors should be closely monitored during the postoperative period.

scholarly journals Risk Factors for Clinically Relevant Postoperative Pancreatic Fistula (CR-POPF) after Distal Pancreatectomy: A Single Center Experience

2020 ◽  
Author(s):  
Gao Qing Wang ◽  
Dipesh Kumar Yadav ◽  
Wei Jiang ◽  
Yong Fei Hua ◽  
Cai De Lu
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Pancreatic Fistula ◽  
Pancreatic Duct ◽  
Distal Pancreatectomy ◽  
Main Pancreatic Duct ◽  
Surgical Complication ◽  
Univariate Analysis ◽  
Postoperative Pancreatic Fistula ◽  
Soft Pancreas

AbstractClinically relevant postoperative pancreatic fistula (CR-POPF) is the considerable contributor to major complications after pancreatectomy. The purpose of this study was to evaluate the potential risk factor contributing to CR-POPF following distal pancreatectomy (DP) and discussed the risk factors of pancreatic fistula in order to interpret the clinical importance. All the patients who underwent DP in between January 2011 and January 2020 were reviewed retrospectively in accordance with relevant guidelines and regulations. The univariate and multivariate analysis was performed was performed to test an independent risk factors for pancreatic fistula. P<0.05 was considered statistically significant. In all of the 263 patients with DP, pancreatic fistula was the most common surgical complication 19.0%. The univariate analysis of 18 factors showed that the patients with a malignant tumor, soft pancreas, and patient without ligation of the main pancreatic duct are more likely to develop pancreatic fistula. However, on multivariate analysis the soft texture of the pancreas (OR= 2.381, P= 0.001) and the ligation of main pancreatic duct (OR= 0.388, P= 0.002) were only an independent influencing factor for CR-POPF. As a conclusion, pancreatic fistula was the most common surgical complication after DP, and the texture of pancreas and ligation of main pancreatic duct can influence an incidence of CR-POPF.

scholarly journals A modified prediction system using combined preoperative anthropomorphic imbalance and fistula risk score for predicting the occurrence of clinically relevant postoperative pancreatic fistula after pancreaticoduodenectomy

2019 ◽  
Author(s):  
Tomoyuki Abe ◽  
Hironobu Amano ◽  
Tsuyoshi Kobayashi ◽  
Minoru Hattori ◽  
Masahiro Nakahara ◽  
...  
Keyword(s):  
Risk Factors ◽  
Adipose Tissue ◽  
Pancreatic Fistula ◽  
Risk Score ◽  
Univariate Analysis ◽  
Incidence Rates ◽  
Postoperative Pancreatic Fistula ◽  
Skeletal Mass ◽  
Tissue Area ◽  
Fistula Risk Score

Abstract Background: The aim of this study was 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 rates of grade B and C CR-POPF were 27% and 4%, respectively. A univariate analysis revealed that male sex, habitual smoking, prognostic nutritional index < 45, VATA/SATA ≥ 0.9, VATA/SMI ≥ 1.4, and FRS > 4 were significantly associated with the incidence of CR-POPF. A multivariate analysis revealed that 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.

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