Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 7, 2019; 25(21): 2650-2664
Published online Jun 7, 2019. doi: 10.3748/wjg.v25.i21.2650
Novel risk scoring system for prediction of pancreatic fistula after pancreaticoduodenectomy
Ye Li, Fang Zhou, Dong-Ming Zhu, Zi-Xiang Zhang, Jian Yang, Jun Yao, Yi-Jun Wei, Ya-Ling Xu, Dei-Chun Li, Jian Zhou
Ye Li, Fang Zhou, Dong-Ming Zhu, Zi-Xiang Zhang, Jian Yang, Jun Yao, Yi-Jun Wei, Ya-Ling Xu, Dei-Chun Li, Jian Zhou, Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
Ye Li, Dong-Ming Zhu, Zi-Xiang Zhang, Jian Yang, Ya-Ling Xu, Dei-Chun Li, Jian Zhou, Pancreatic Disease Research Centre, The First Affiliated Hospital of Soochow University, Suzhou 215006, Jiangsu Province, China
Author contributions: Li Y and Zhou F contributed equally to this work; Li Y, Zhou F, Li DC, and Zhou J contributed to study conception and design; Li Y, Zhou F, Yang J, Yao J, Zhu DM, and Zhang ZX contributed to provision of study material or patients; Li Y, Zhou F, Wei YJ, and Yao J contributed to collection and/or assembly of data; Li Y, Xu YL, Li DC, and Zhou J contributed to data analysis and interpretation; Li Y, Zhou F, and Zhou J wrote the manuscript.
Supported by the Key Research and Development of Jiangsu Province of China, No. BE2016673; the Jiangsu Province "333" Project, No. BRA2018392; the Jiangsu Provincial Medical Youth Talent, No. QNRC2016734; Six Talent Peaks Project in Jiangsu Province, No. WSW-059; and the Project of Suzhou People’s Livelihood Science and Technology, No. SS201632.
Institutional review board statement: The study was approved by the ethics committee of the First Affiliated Hospital of Soochow University.
Informed consent statement: The need for individual consent was waived by the committee because of the retrospective nature of the study.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jian Zhou, MD, Doctor, Department of General Surgery, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou 215006, Jiangsu Province, China. zhoujian06@suda.edu.cn
Telephone: +86-13511602860 Fax: +86-512-67780107
Received: February 27, 2019
Peer-review started: February 27, 2019
First decision: March 14, 2019
Revised: April 24, 2019
Accepted: May 3, 2019
Article in press: May 8, 2019
Published online: June 7, 2019
Processing time: 99 Days and 22.7 Hours
Abstract
BACKGROUND

The available prediction models for clinically relevant postoperative pancreatic fistula (CR-POPF) do not incorporate both preoperative and intraoperative variables.

AIM

To construct a new risk scoring system for CR-POPF that includes both preoperative and intraoperative factors.

METHODS

This was a retrospective study of patients who underwent pancreaticoduodenectomy (PD) or pylorus-preserving PD (PPPD) between January 2011 and December 2016 at the First Affiliated Hospital of Soochow University. Patients were divided into a study (01/2011 to 12/2014) or validation (01/2015 to 12/2016) group according to the time of admission. POPF severity was classified into three grades: Biochemical leak (grade A) and CR-POPF (grades B and C). Logistic regression was used to create a predictive scoring system.

RESULTS

Preoperative serum albumin ≥ 35 g/L [P = 0.032, odds ratio (OR) = 0.92, 95% confidence interval (CI): 0.85-0.99], hard pancreatic texture (P = 0.004, OR = 0.25, 95%CI: 0.10-0.64), pancreatic duct diameter ≥ 3 mm (P = 0.029, OR = 0.50, 95%CI: 0.27-0.93), and intraoperative blood loss ≥ 500 mL (P = 0.006, OR = 1.002, 95%CI: 1.001-1.003) were independently associated with CR-POPF. We established a 10-point risk scoring system to predict CR-POPF. The area under the curve was 0.821 (95%CI: 0.736-0.905) and the cut-off value was 3.5. Including drain amylase levels improved the predictive power of the model.

CONCLUSION

This study established a 10-point scoring system to predict CR-POPF after PD/PPPD using preoperative and intraoperative parameters. Ultimately, this system could be used to distinguish between high- and low-risk populations in order to facilitate timely interventions after PD.

Keywords: Postoperative; Pancreatic fistula; Pancreaticoduodenectomy; Risk factor; Predictive model; Complications; Scoring system

Core tip: This study established a 10-point scoring system to predict clinically relevant postoperative pancreatic fistula after pancreaticoduodenectomy or pylorus-preserving pancreaticoduodenectomy using preoperative and intraoperative parameters. Ultimately, this system could be used to distinguish between high- and low-risk populations in order to facilitate timely interventions after pancreaticoduodenectomy.