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:
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.
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
Research background

Pancreaticoduodenectomy (PD) is associated with significant postoperative morbidity. Clinically relevant postoperative pancreatic fistula (CR-POPF) is among the most common complications after PD and may have serious consequences for the patients. Factors such as age, body mass index, preoperative serum total bilirubin, operative time, operative blood loss, pancreatic duct diameter, and pancreatic texture are known to influence the occurrence of CR-POPF.

Research motivation

Both preoperative and intraoperative variables should be included in the same model for the prediction of CR-POPF, but the available models do not incorporate both preoperative and intraoperative variables.

Research objectives

This study aimed to construct a new risk scoring system for CR-POPF that include both preoperative and intraoperative factors.

Research methods

This was a retrospective study of patients who underwent 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.

Research 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. Taken together, these results suggest that this 10-point risk scoring system could predict CR-POPF after PD/PPPD.

Research conclusions

The present 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.

Research perspectives

This system is original and has not been proposed before. Nevertheless, this scoring system will have to be validated prospectively. We hypothesize that this risk scoring system will effectively predict CR-POPF in clinical practice.