Preoperative risk stratification of postoperative pancreatic fistula: A risk-tree predictive model for pancreatoduodenectomy.

Published on Jul 24, 2021in Surgery3.356
· DOI :10.1016/J.SURG.2021.06.046
Giampaolo Perri9
Estimated H-index: 9
,
Giovanni Marchegiani29
Estimated H-index: 29
+ 8 AuthorsClaudio Bassi110
Estimated H-index: 110
Sources
Abstract
Abstract null null Background null Existing postoperative pancreatic fistula risk scores rely on intraoperative parameters, which limits their value in the preoperative setting. A preoperative predictive model to stratify the risk of developing postoperative pancreatic fistula before pancreatoduodenectomy was built and externally validated. null null null Methods null A regression risk-tree model for preoperative postoperative pancreatic fistula risk stratification was developed in the Verona University Hospital training cohort using preoperative variables and then tested prospectively in a validation cohort of patients who underwent pancreatoduodenectomy at San Raffaele Hospital of Milan. null null null Results null In the study period 566 (training cohort) and 456 (validation cohort) patients underwent pancreatoduodenectomy. In the multivariable analysis body mass index, radiographic main pancreatic duct diameter and American Society of Anesthesiologists score ≥3 were independently associated with postoperative pancreatic fistula. The regression tree analysis allocated patients into 3 preoperative risk groups with an 8%, 21%, and 32% risk of postoperative pancreatic fistula (all P null null null null Conclusion null In candidates for pancreatoduodenectomy, the risk of postoperative pancreatic fistula can be quickly and accurately determined in the preoperative setting based on the body mass index and main pancreatic duct diameter at radiology. Preoperative risk stratification could potentially guide clinical decision-making, improve patient counseling and allow the establishment of personalized preoperative protocols.
References29
Newest
#1Claudio Bassi (UniSR: Vita-Salute San Raffaele University)H-Index: 5
Last. Roberto SalviaH-Index: 52
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Objective The aim of the present study was to critically reappraise the experience at our high-volume institution to obtain new insights for future directions. Summary background data The indications, surgical techniques, and perioperative management of pancreatoduodenectomy (PD) have profoundly evolved over the last 20 years. Methods All consecutive PDs performed during the last 20 years at the Verona Pancreas Institute were divided into four 5-year timeframes and retrospectively analyzed in te...
4 CitationsSource
#1Xi-Yu Wang (SYSU: Sun Yat-sen University)H-Index: 1
#2Jian-Peng Cai (SYSU: Sun Yat-sen University)H-Index: 7
Last. Xiao-Yu Yin (SYSU: Sun Yat-sen University)H-Index: 15
view all 5 authors...
Abstract Background Enhanced recovery after surgery (ERAS) has been widely applied in many surgical specialties. However, with respect to the impact of ERAS on pancreaticoduodenectomy (PD), there still exist some controversies. Methods Literature search was performed in PubMed, Web of Science and the Cochrane Library from January, 1990 to July, 2019. A meta-analysis was performed using fixed-effects or random-effects models. Results Twenty-two studies containing 4147 patients were identified. Th...
11 CitationsSource
#1Stefano Andrianello (University of Verona)H-Index: 16
#2Giovanni Marchegiani (University of Verona)H-Index: 29
Last. Claudio Bassi (University of Verona)H-Index: 110
view all 12 authors...
Importance The operative scenarios with the highest postoperative pancreatic fistula (POPF) risk represent situations in which fistula prevention and mitigation strategies have the strongest potential to affect surgical outcomes after pancreaticoduodenectomy. Evidence from studies providing risk stratification is lacking. Objective To investigate whether pancreaticojejunostomy (PJ) or pancreaticogastrostomy (PG), both with externalized transanastomotic stent, is the best reconstruction method fo...
25 CitationsSource
#1Tommaso Giuliani (University of Verona)H-Index: 5
#2Stefano Andrianello (University of Verona)H-Index: 16
Last. Roberto Salvia (University of Verona)H-Index: 52
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Abstract Background Scores predicting postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD) mainly use intraoperative predictors. The aim of this study is to investigate the role of pancreatic exocrine function expressed by fecal elastase (FE-1) as preoperative predictor of POPF. Methods Patients scheduled for PD at the Department of General and Pancreatic Surgery, University of Verona Hospital, from April 2017 to July 2018 were prospectively enrolled. FE-1 was measured in a...
7 CitationsSource
#1Timothy E. Newhook (University of Texas MD Anderson Cancer Center)H-Index: 13
#2Eduardo A. Vega (University of Texas MD Anderson Cancer Center)H-Index: 8
Last. Ching Wei D. Tzeng (University of Texas MD Anderson Cancer Center)H-Index: 33
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Abstract Background First postoperative day drain fluid amylase (DFA1) Methods Patients with DFA1/DFA3 values after pancreaticoduodenectomy or distal pancreatectomy were identified. Patients were risk stratified as “low-risk pancreaticoduodenectomy,” “high-risk pancreaticoduodenectomy,” or “distal pancreatectomy.” Receiver operator characteristic analyses yielded clinically relevant sensitivity thresholds for International Study Group on Pancreatic Surgery grade B/C postoperative pancreatic fist...
6 CitationsSource
#1Ryan J. Ellis (ACS: American College of Surgeons)H-Index: 9
#2D. Brock Hewitt (NU: Northwestern University)H-Index: 8
Last. Anthony D. Yang (NU: Northwestern University)H-Index: 24
view all 8 authors...
BACKGROUND: Pancreatic fistula remains common, with limited ability to risk stratify patients preoperatively. The objective of this study was to identify risk factors for clinically-relevant postoperative pancreatic fistula (CR-POPF) that are routinely available in the preoperative setting. METHODS: Preoperatively available variables for all pancreaticoduodenectomies from 2014-2017 were examined using a national clinical registry. The cohort was separated into risk factor identification and inte...
18 CitationsSource
#1Jason W. Denbo (UMN: University of Minnesota)H-Index: 14
#2Morgan L. Bruno (University of Texas MD Anderson Cancer Center)H-Index: 6
Last. Matthew H.G. Katz (University of Texas MD Anderson Cancer Center)H-Index: 66
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Abstract Background Postoperative pancreatic fistula is associated with adverse events, increased duration of stay and hospital costs. We developed perioperative care pathways stratified by postoperative pancreatic fistula risk with the aims of minimizing variations in care, improving quality, and decreasing costs. Study Design Three unique risk-stratified pancreatectomy clinical pathways—low-risk pancreatoduodenectomy, high-risk pancreatoduodenectomy, and distal pancreatectomy were developed an...
19 CitationsSource
#1Giovanni Marchegiani (University of Verona)H-Index: 29
#2Stefano Andrianello (University of Verona)H-Index: 16
Last. Roberto Salvia (University of Verona)H-Index: 52
view all 10 authors...
Background Neoadjuvant therapy (NAT) is used for borderline-resectable or locally advanced pancreatic cancer (PDAC) and exhibits promising results in terms of pathological outcomes. However, little is known about its effect on surgical complications.
42 CitationsSource
#1Anthony Visioni (Roswell Park Cancer Institute)H-Index: 3
#2Rupen Shah (Roswell Park Cancer Institute)H-Index: 9
Last. Steven J. Nurkin (Roswell Park Cancer Institute)H-Index: 17
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Objective:To evaluate the impact of enhanced recovery after surgery (ERAS) protocols across noncolorectal abdominal surgical procedures.Background:ERAS programs have been studied extensively in colorectal surgery and adopted at many centers. Several studies testing such protocols have shown promisin
107 CitationsSource
#1Riccardo Casadei (UNIBO: University of Bologna)H-Index: 31
#2Claudio Ricci (UNIBO: University of Bologna)H-Index: 28
Last. Francesco Minni (UNIBO: University of Bologna)H-Index: 26
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Abstract Background In 2015, basing on objective preoperative factors related to pancreas remnant texture (body mass index, Wirsung duct size and preoperative diagnosis), we proposed a score model to predict the risk of postoperative pancreatic fistula after partial pancreatectomies. The aim of the present study was to prospectively validate this preoperative predictive risk score for postoperative pancreatic fistula after pancreaticoduodenectomy. Methods Prospective study of consecutive patient...
21 CitationsSource
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#1Charles M. Vollmer (UPenn: University of Pennsylvania)H-Index: 67
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