Validation of original and alternative fistula risk scores in postoperative pancreatic fistula

Ryu, Yoshinori; Shin, Sang Hyun; Park, Dae Joon; Kim, Naru; Heo, Jin Seok; Choi, Dong Wook; Han, In Woong

doi:10.1002/jhbp.638

Cited by 42 publications

(48 citation statements)

References 30 publications

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“…However, the new criteria that do not include the DFA markedly reduced the incidence of CR-POPF as well as the incidence of the Clavien-Dindo grade ≥ 3 complications in both the validation and further assessment cohorts. Numerous attempts to reduce CR-POPF have been reported [7][8][9][10][11][12][13][14][15]20,23 , and these studies revealed the proper management of prophylactic drain(s) is the most important issue. Intra-abdominal infection was strongly associated with the development of CR-POPF 9,10,[11][12][13][14]22 .…”

Section: Discussionmentioning

confidence: 99%

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Prophylactic drain management after pancreaticoduodenectomy without focusing on the drain fluid amylase level: A prospective validation study regarding criteria for early drain removal that do not include the drain fluid amylase level

Taniguchi

Matsuyama

Yabushita

et al. 2020

J Hepato Biliary Pancreat

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Background/Purpose: Early drain removal (EDR) based on drain fluid amylase level (DFA) after pancreaticoduodenectomy excluded 15%-40% patients from EDR because of inappropriate DFA. Methods: Of 198 pancreatoduodenectomy cases, we used the first 105 cases as an exploration cohort to construct the optimal criteria for EDR on postoperative day (POD)4 that were applied to the subsequent 93 cases used as the validation cohort. After that, we examined another 142 patients to further assess the efficacy of the new EDR criteria. Results: Of the four independent predictors of clinically relevant postoperative pancreatic fistula (CR-POPF) ([1] soft pancreas, [2] positive drain fluid culture on POD1, and [3] serum C-reactive protein [CRP] ≥13 mg/dL on POD4) in the exploration cohort, EDR was applied to cases in the validation cohort meeting the [2] and/or [3], enabling 96% (89/93) applicability of EDR. Outcomes were improved in the validation cohort compared to the exploration cohort; CR-POPF: 8.6% vs 25.7%, P = .005; Dindo-Clavien grade ≥ 3 complications: 23.7% vs 41.9%, P = .007; and median hospital stay (day): 21 vs 27, P = .005. The subsequent 142 patients showed 92% (131/142) applicability of EDR and 5.6% (8/142) incidence of CR-POPF. Conclusions: Our new criteria for EDR, without DFA, enabled ≥ 90% applicability of EDR and reduced CR-POPF. K E Y W O R D S clinical outcomes, criteria, early drain removal, pancreaticoduodenectomy, postoperative pancreatic fistula | 951 TANIGUCHI eT Al. How to cite this article: TaniguchiK, Matsuyama R, Yabushita Y, et al. Prophylactic drain management after pancreaticoduodenectomy without focusing on the drain fluid amylase level: A prospective validation study regarding criteria for early drain removal that do not include the drain fluid amylase level.

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Section: Discussionmentioning

confidence: 99%

“…Numerous attempts to reduce CR‐POPF have been reported 7‐10,11‐15,20,23 , and these studies revealed the proper management of prophylactic drain(s) is the most important issue. Intra‐abdominal infection was strongly associated with the development of CR‐POPF 9,10,11‐14,22 .…”

Section: Discussionmentioning

confidence: 99%

Prophylactic drain management after pancreaticoduodenectomy without focusing on the drain fluid amylase level: A prospective validation study regarding criteria for early drain removal that do not include the drain fluid amylase level

Taniguchi

Matsuyama

Yabushita

et al. 2020

J Hepato Biliary Pancreat

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“…Some studies believe that the influencing factors of pancreatic fistula after splenectomy are mainly related to the grading of liver function, blood coagulation mechanism, the texture of pancreas, the size of spleen, the degree of hypersplenism, and the operation method. [14][15][16] In the present work, we elucidate and analyze the following three representative influencing factors. 1) Grading of liver function and blood coagulation mechanism: The impairment of liver function is also related to the blood coagulation mechanism of patients, which is affected by intraoperative clamping and, meanwhile, increasing hemostasis by ligation that easily injure pancreatic tissue.…”

Section: Discussionmentioning

confidence: 99%

Significance of Amylase Monitoring in Peritoneal Drainage Fluid after Splenectomy: A Clinical Analysis of Splenectomy in 167 Patients with Hepatolenticular Degeneration

Shen

Guo

Laiyong

et al. 2020

The American Surgeon™

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Different kinds of complications after splenectomy in hepatolenticular degeneration patients with hypersplenism have been reported in the past decades, but studies on pancreatic fistula and the corresponding targeted prevention and treatment after splenectomy still remain much unexplored. The present work investigated the pathogenic factors of pancreatic fistula after splenectomy and the variation tendency of amylase in drainage fluid, aiming to verify the significance of monitoring amylase in the abdominal drainage fluid in the early diagnosis of pancreatic fistula after splenectomy. One hundred sixty-seven patients with hepatolenticular degeneration and hypersplenism who underwent splenectomy in the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine from January 2016 to August 2018 were selected and analyzed. The amylase in the abdominal drainage fluid was monitored routinely after splenectomy. We also conducted the statistics on the incidence of different types of pancreatic fistula and analyzed the influence factors of pancreatic fistula formation. After splenectomy, biochemical fistula occurred in 11 patients (6.6%), grade B fistula in six patients (3.6%), grade C fistula in one patient (0.6%), and the incidence of pancreatic fistula was 4.2 per cent (biochemical fistula excluded). The amylase in the peritoneal drainage fluid was closely concerned with the incidence of pancreatic fistula according to our statistics. Furthermore, by analyzing the different influence factors of pancreatic fistula, Child-Pugh grading of liver function ( P = 0.041), pancreatic texture ( P = 0.029), degree of splenomegaly ( P = 0.003), and operative method ( P = 0.001) were supposed to be closely related to the formation of pancreatic fistula. Monitoring of amylase in peritoneal drainage fluid is regarded as an important physiological parameter in the early diagnosis of pancreatic fistula after splenectomy, which provides effective clinical reference and plays a significant role in preventing the occurrence and development of pancreatic fistula.

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“…Numerous risk factors for POPF have been identified, such as sex, pancreatic texture, blood loss, and main pancreatic duct diameter; however, most of these predictors are subjective and contradictory [ 10 ]. Several predictive models have also been proposed, among which the fistula risk score and alternative fistula risk score (a-FRS) are most commonly used [ 9 , 10 ]. However, the performances of those models were recently suggested to have low predictive value for external validation [ 9 , 10 , 14 , 15 ] .…”

Section: Introductionmentioning

confidence: 99%

Predictive nomogram for postoperative pancreatic fistula following pancreaticoduodenectomy: a retrospective study

et al. 2021

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Background Postoperative pancreatic fistula (POPF) represents the most common complication following pancreaticoduodenectomy (PD). Predictive models are needed to select patients with a high risk of POPF. This study was aimed to establish an effective predictive nomogram for POPF following PD. Methods Consecutive patients who had undergone PD between January 2016 and May 2020 at a single institution were analysed retrospectively. A predictive nomogram was established based on a training cohort, and Lasso regression and multivariable logistic regression analysis were used to evaluate predictors. The predictive abilities of the predicting model were assessed for internal validation by the area under the receiver operating characteristic curve (AUC) and calibration plot using bootstrap resampling. The performance of the nomogram was compared with that of the currently used a-FRS model. Results A total of 459 patients were divided into a training cohort (n = 302) and a validation cohort (n = 157). No significant difference was observed between the two groups with respect to clinicopathological characteristics. The POPF rate was 16.56%. The risk factors of POPF POPF were albumin difference, drain amylase value on postoperative day 1, pancreas texture, and BMI, which were all selected into a nomogram. Nomogram application revealed good discrimination (AUC = 0.87, 95% CI: 0.81–0.94, P < 0.001) as well as calibration abilities in the validation cohort. The predictive value of the nomogram was better than that of the a-FRS model (AUC: 0.87 vs 0.62, P < 0.001). Conclusions This predictive nomogram could be used to evaluate the individual risk of POPF in patients following PD, and albumin difference is a new, accessible predictor of POPF after PD. Trial registration This study was registered in the Chinese Clinical Trial Register (ChiCTR2000034435).

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Validation of original and alternative fistula risk scores in postoperative pancreatic fistula

Cited by 42 publications

References 30 publications

Prophylactic drain management after pancreaticoduodenectomy without focusing on the drain fluid amylase level: A prospective validation study regarding criteria for early drain removal that do not include the drain fluid amylase level

Prophylactic drain management after pancreaticoduodenectomy without focusing on the drain fluid amylase level: A prospective validation study regarding criteria for early drain removal that do not include the drain fluid amylase level

Significance of Amylase Monitoring in Peritoneal Drainage Fluid after Splenectomy: A Clinical Analysis of Splenectomy in 167 Patients with Hepatolenticular Degeneration

Predictive nomogram for postoperative pancreatic fistula following pancreaticoduodenectomy: a retrospective study

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