Clinical validation of the risk scoring systems of postoperative pancreatic fistula after laparoscopic pancreatoduodenectomy in Chinese cohorts: A single-center retrospective study

Niu, Chunyuan; Chen, Qingmin; Liu, Songyang; Zhang, Wei; Jiang, Peiqiang; Liu, Yahui

doi:10.1016/j.surg.2021.08.013

Cited by 7 publications

(3 citation statements)

References 41 publications

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“…The diameter of pancreatic duct (5, 28, 29) is related to LPPC, which with excessively thin duct is associated to the higher occurrence of damage in the pancreas when anastomosing with jejunum mucosa, and difficult to exact anastomosis. Another study in our center (27) demonstrated the diameter of small pancreatic duct as an independent risk factor for postoperative POPF (OR: 30.277, 95% CI: 10.578-86.655, P < 0.001), which was also verified in other studies. However, the expanded sample size resulted in the statistically insignificant diameter of pancreatic duct in the multivariate analysis in the present study.…”

Section: Discussionsupporting

confidence: 86%

“…This study suggests hyperbilirubinemia as an independent risk factor for postoperative complications of LPD, and is closely associated with the incidence of severe complications, which may even contribute to postoperative deterioration of the disease. One study (27) from a large capacity center in western China covering 1056 patients also identified hyperbilirubinemia as an independent risk factor for LPPC, especially highly correlated with Grade V (P = 0.042, 95% CI: 1.849 to 4.789, OR = 2.017). In univariate analysis, preoperative biliary drainage exhibited no statistical significance after excluding the interference of other factors after inclusion in regression model.…”

Section: Discussionmentioning

confidence: 99%

“…During pancreatic jejunal anastomosis after LPD, it is easy to corrode the anastomotic vessels and tissues. Secondly, when the soft pancreas is anastomosed with the residual pancreas, cutting effect is more likely appear by the suture and lead to pancreatic damage, which will cause POPF, resulting in bleeding, abdominal infection, sepsis and other complications, which has reached a consensus in academic (27)(28)(29)(30). The pancreas with low density is more sensitive to inflammation compared to those with high fibrosis.…”

Section: Discussionmentioning

confidence: 99%

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Application of Clavien–Dindo classfication-grade in evaluating overall efficacy of laparoscopic pancreaticoduodenectomy

Song

Shi

et al. 2023

Front. Surg.

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BackgroundThe Clavien–Dindo classification (CDC) has been widely accepted and applied in clinical practice. We investigated its effectiveness in prediction of major complications (LPPC) after laparoscopic pancreaticoduodenectomy (LPD) and associated risk factors.MethodsA retrospective analysis was conducted covering clinical data of 793 patients undergoing LPD from April 2015 to November 2021. CDC was utilized to grade postoperative complications and analyze the differences. Risk factors of LPPC were identified according to univariate and multivariate analyses.ReslutsFor the 793 patients undergoing laparoscopic pancreaticoduodenectomy in the northeast of China, LPPC was reported in 260 (32.8%) patients, pancreatic fistula in 169 (21.3%), biliary fistula in 44 (5.5%), delayed gastric emptying in 17(2.1%), post pancreatectomy hemorrhage in 55 (6.9%), intestinal fistula in 7 (0.8%), abdominal infections in 59 (7.4%) and pulmonary complication in 28 (3.5%). All complications were classified into five levels with the C–D classification (Grade I–V), with 83 (31.9%) patients as grade I, 91 (35.0%) as grade II, 38 (14.6%) as grade IIIa, 24 (9.2%) as grade IIIb, 9 (3.5%) as grade IV and 15 (5.8%) as grade V. 86 (10.8%) patients experienced major complications (grade III–V).The results of univariate and multivariate analysis revealed the independent risk factors for laparoscopic pancreaticoduodenectomy complications to be preoperative total bilirubin (P = 0.029, OR = 1.523), soft pancreas texture (P < 0.001, OR = 1.399), male (P = 0.038, OR = 1.396) and intraoperative transfusion (P = 0.033, OR = 1.517). Preoperative total bilirubin (P = 0.036, OR = 1.906) and intraoperative transfusions (P = 0.004, OR = 2.123) were independently associated with major postoperative complications. The influence of different bilirubin levels on C–D grade of complications was statistically significant (P = 0.036, OR = 1.906).ConclusionsThe Clavien–Dindo classification (CDC) may serve as a valid tool to predict major postoperative complications and contribute to perioperative management and comparison of surgical techniques in different medical centers.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%