Optimizing prediction models for pancreatic fistula after pancreatectomy: Current status and future perspectives

Table 1 Reported risk factors for postoperative pancreatic fistula after pancreaticoduodenectomy

Stage	Factors
Preoperative	(1) Sex, (2) age, (3) BMI, (4) weight, (5) weight loss, (6) smoking history, (7) hypertension, (8) diabetes mellitus, (9) history of acute pancreatitis, (10) history of abdominal surgery, (11) chronic steroid use, (12) ASA score, (13) preoperative biliary drainage, (14) preoperative chemotherapy, (15) albumin, (16) bilirubin, (17) alanine transaminase, (18) creatine, (19) tumor site, (20) MPD diameter, (21) MPD index1, (22) pancreatic thickness, (23) pancreatic density, (24) pancreatic texture, (25) relation with PV on CT, (26) pancreatic density index, (27) intra-abdominal fat thickness, (28) visceral adipose tissue, (29) total adipose tissue, (30) sarcopenic obesity, (31) L3 subcutaneous fat area, (32) pancreatic remnant volume, (33) stump area, (34) fat score, (35) atrophy score, (36) A/L ratio, (37) subcutaneous fat index, (38) radiomics score, (39) combined radiomics score, (40) liver density, (41) muscle attenuation, (42) PS SIratio, (43) PM SIratio, (44) fat mass at BIVA, (45) SWV value of pancreas, (46) MIPD experience, (47) preoperative diagnosis
Intraoperative	(A) MPD diameter, (B) pancreatic texture, (C) operating time, (D) estimated blood loss, (E) transfusion, (F) intraoperative colloid infusion, (G) surgical approach, (H) minimally invasive approach, (I) open conversion, (J) pancreatic anastomosis, (K) gastrojejunostomy, (L) extended lymphadenectomy, (M) venous resection, (N) nasojejunal feeding tube
Postoperative	(a) Postoperative DFA, (b) change of postoperative DFA, (c) WBC on POD1, (d) change of postoperative WBC, (e) neutrophil on POD3, (f) postoperative CRP, (g) temperature on POD3, (h) postoperative albumin, (i) albumin difference2, (j) postoperative CRP/albumin, (k) serum creatinine on POD1, (l) hyperamylasemia on POD1-2, (m) serum lipase on POD1, (n) DFL on POD1, (o) pathology, (p) PV invasion, (q) pancreatic fibrosis, (r) pancreatic steatosis, (s) deep surgical site infection, (t) DGE

¹Main pancreatic duct index indicates the ratio of main pancreatic duct diameter to pancreatic thickness at the transection site.

²Albumin difference indicates the difference of albumin level between preoperative and postoperative day 1.

A/L ratio: Arterial/late phase pancreas computed tomography attenuation value ratio; ASA: American Society of Anesthesiologists; BIVA: Bioimpedance vector analysis; BMI: Body mass index; CRP: C-reactive protein; CT: Computed tomography; DFA: Drain fluid amylase; DFL: Drain fluid lipase; DGE: Delayed gastric emptying; L3: The third lumbar vertebra; MIPD: Minimally invasive pancreaticoduodenectomy; MPD: Main pancreatic duct; POD: Postoperative day; PV: Portal vein; SWV: Shear wave velocity; PM SIratio: Signal intensity ratio of pancreas to muscle; PS SIratio: Signal intensity ratio of pancreas to spleen; WBC: White blood cell.