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Combined pre-operative risk score predicts pancreatic leak after pancreatic resection

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Abstract

Background

Post-operative pancreatic fistula (POPF) is a major complication following pancreatectomy and is currently difficult to predict pre-operatively. This study aims to validate pre-operative risk factors and develop a novel combined score for the prediction of POPF in the pre-operative setting.

Methods

Data were collected from 2016 to 2021 for radiologic main pancreatic duct diameter (MPD), body mass index (BMI), physical status classified by American Society of Anesthesiologists (ASA), polypharmacy, mean platelet ratio (MPR), comorbidity-polypharmacy score (CPS), and a novel Combined Pancreatic Leak Prediction Score (CPLPS) (derived from MPD diameter, BMI, and CPS) were obtained from pre-operative data and analyzed for their independent association with POPF occurrence.

Results

In total, 166 patients who underwent pancreatectomy with pancreatic leak (Grade A, B, and C) occurring in 51(30.7%) of patients. Pre-operative radiologic MPD diameter < 4 mm (p < 0.001), < 5 mm (p < 0.001), < 6 mm (p = 0.001), BMI ≥ 25 (p = 0.009), and ≥ 30 (p = 0.017) were independently associated with the occurrence of pancreatic leak. CPLPS was also predictive of pancreatic leak following pancreatectomy on univariate (p = 0.005) and multivariate analysis (p = 0.036).

Conclusion

MPD and BMI were independent risk factors predictive for the development of pancreatic leak. CPLPS, was an independent predictor of pancreatic leak following pancreatectomy and could be used to help guide surgical decision making and patient counseling.

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References

  1. Pillai SA, Palaniappan R, Pichaimuthu A, Rajendran KK, Sathyanesan J, Govindhan M (2014) Feasibility of implementing fast-track surgery in pancreaticoduodenectomy with pancreaticogastrostomy for reconstruction—a prospective cohort study with historical control. Int J Surg 12(9):1005–1009

    Article  PubMed  Google Scholar 

  2. Griffin JF, Poruk KE, Wolfgang CL (2015) Pancreatic cancer surgery: past, present, and future. Chin J Cancer Res 27(4):332–348

    CAS  PubMed  PubMed Central  Google Scholar 

  3. Butturini G, Marcucci S, Molinari E et al (2006) Complications after pancreaticoduodenectomy: the problem of current definitions. J Hepatobiliary Pancreat Surg 13(3):207–211

    Article  PubMed  Google Scholar 

  4. Allen PJ, Gönen M, Brennan MF et al (2014) Pasireotide for postoperative pancreatic fistula. N Engl J Med 370(21):2014–2022

    Article  PubMed  Google Scholar 

  5. Zhang B, Yuan Q, Li S et al (2022) Risk factors of clinically relevant postoperative pancreatic fistula after pancreaticoduodenectomy: a systematic review and meta-analysis. Medicine 101(26):e29757

    Article  PubMed  PubMed Central  Google Scholar 

  6. Wang XY, Cai JP, Huang CS, Huang XT, Yin XY (2020) Impact of enhanced recovery after surgery protocol on pancreaticoduodenectomy: a meta-analysis of non-randomized and randomized controlled trials. HPB 22(10):1373–1383

    Article  PubMed  Google Scholar 

  7. Cao Y, Gu HY, Huang ZD et al (2019) Impact of enhanced recovery after surgery on postoperative recovery for pancreaticoduodenectomy: pooled analysis of observational study. Front Oncol 9:687

    Article  PubMed  PubMed Central  Google Scholar 

  8. Aranha GV, Aaron JM, Shoup M, Pickleman J (2006) Current management of pancreatic fistula after pancreaticoduodenectomy. Surgery 140(4):561–568 (discussion 568–569)

    Article  PubMed  Google Scholar 

  9. Perri G, Marchegiani G, Partelli S et al (2021) Preoperative risk stratification of postoperative pancreatic fistula: a risk-tree predictive model for pancreatoduodenectomy. Surgery 170(6):1596–1601

    Article  PubMed  Google Scholar 

  10. Pulvirenti A, Ramera M, Bassi C (2017) Modifications in the International Study Group for Pancreatic Surgery (ISGPS) definition of postoperative pancreatic fistula. Transl Gastroenterol Hepatol 2:107

    Article  PubMed  PubMed Central  Google Scholar 

  11. Harnoss JC, Ulrich AB, Harnoss JM, Diener MK, Buchler MW, Welsch T (2014) Use and results of consensus definitions in pancreatic surgery: a systematic review. Surgery 155(1):47–57

    Article  PubMed  Google Scholar 

  12. Pecorelli N, Pagnanelli M, Cinelli L et al (2019) Postoperative outcomes and functional recovery after preoperative combination chemotherapy for pancreatic cancer: a propensity score-matched study. Front Oncol 9:1299

    Article  PubMed  PubMed Central  Google Scholar 

  13. Lapshyn H, Petruch N, Thomaschewski M et al (2021) A simple preoperative stratification tool predicting the risk of postoperative pancreatic fistula after pancreatoduodenectomy. Pancreatology 21(5):957–964

    Article  PubMed  Google Scholar 

  14. Lale A, Kirmizi I, Hark BD et al (2022) Predictors of Postoperative Pancreatic Fistula (POPF) After Pancreaticoduodenectomy: clinical significance of the Mean Platelet Volume (MPV)/platelet count ratio as a new predictor. J Gastrointest Surg 26(2):387–397

    Article  PubMed  Google Scholar 

  15. Roberts KJ, Hodson J, Mehrzad H et al (2014) A preoperative predictive score of pancreatic fistula following pancreatoduodenectomy. HPB 16(7):620–628

    Article  PubMed  Google Scholar 

  16. Pyo JS, Sohn JH, Kang G (2016) Diagnostic and prognostic roles of the mean platelet volume in malignant tumors: a systematic review and meta-analysis. Platelets 27(8):722–728

    Article  CAS  PubMed  Google Scholar 

  17. Camur S, Celik H (2019) Prediction of the mortality with comorbidity—polypharmacy score in the osteoporotic hip fractures. Acta Chir Orthop Traumatol Cech 86(5):320–323

    Article  CAS  PubMed  Google Scholar 

  18. Chua MT, Bhandari K, Ong VY, Kuan WS (2017) Road crashes in older persons and the use of comorbidity polypharmacy score in an Asian population. Ann Acad Med Singap 46(5):185–194

    Article  PubMed  Google Scholar 

  19. Housley BC, Stawicki SP, Evans DC, Jones C (2015) Comorbidity-polypharmacy score predicts readmission in older trauma patients. J Surg Res 199(1):237–243

    Article  PubMed  Google Scholar 

  20. Holmes M, Garver M, Albrecht L, Arbabi S, Pham TN (2014) Comparison of two comorbidity scoring systems for older adults with traumatic injuries. J Am Coll Surg 219(4):631–637

    Article  PubMed  Google Scholar 

  21. Justiniano CF, Evans DC, Cook CH et al (2013) Comorbidity-polypharmacy score: a novel adjunct in post-emergency department trauma triage. J Surg Res 181(1):16–19

    Article  PubMed  Google Scholar 

  22. Justiniano CF, Coffey RA, Evans DC et al (2015) Comorbidity-polypharmacy score predicts in-hospital complications and the need for discharge to extended care facility in older burn patients. J Burn Care Res 36(1):193–196

    Article  PubMed  Google Scholar 

  23. Nossaman VE, Larsen BE, DiGiacomo JC et al (2018) Mortality is predicted by comorbidity polypharmacy score but not Charlson Comorbidity Index in geriatric trauma patients. Am J Surg 216(1):42–45

    Article  PubMed  Google Scholar 

  24. Vauthey JN, Dixon E (2009) AHPBA/SSO/SSAT consensus conference on resectable and borderline resectable pancreatic cancer: rationale and overview of the conference. Ann Surg Oncol 16(7):1725–1726

    Article  PubMed  Google Scholar 

  25. Tempero MA, Malafa MP, Al-Hawary M et al (2017) Pancreatic adenocarcinoma, Version 2.2017, NCCN clinical practice guidelines in oncology. J Natl Compr Cancer Netw 15(8):1028–1061

    Article  Google Scholar 

  26. Salvia R, Malleo G, Marchegiani G, Butturini G, Esposito A, Bassi C (2014) Pancreaticoduodenectomy with harmonic focust curved shears for cancer. Dig Surg 31(4–5):249–254

    Article  PubMed  Google Scholar 

  27. Wehry J, Agle S, Philips P et al (2015) Restrictive blood transfusion protocol in malignant upper gastrointestinal and pancreatic resections patients reduces blood transfusions with no increase in patient morbidity. Am J Surg 210(6):1197–1204 (discussion 1204–1195)

    Article  PubMed  PubMed Central  Google Scholar 

  28. Bhutiani N, Quinn SA, Jones JM et al (2018) The impact of enhanced recovery pathways on cost of care and perioperative outcomes in patients undergoing gastroesophageal and hepatopancreatobiliary surgery. Surgery 164(4):719–725

    Article  PubMed  Google Scholar 

  29. Sato S, Nakatani E, Higashizono K et al (2022) The impact of the American Society of Anesthesiology-Physical Status classification system on the treatment and prognosis of patients with esophageal cancer undergoing esophagectomy. Int J Clin Oncol 27(8):1289–1299

    Article  PubMed  Google Scholar 

  30. Evans DC, Cook CH, Christy JM et al (2012) Comorbidity-polypharmacy scoring facilitates outcome prediction in older trauma patients. J Am Geriatr Soc 60(8):1465–1470

    Article  PubMed  Google Scholar 

  31. Davenport DL, Bowe EA, Henderson WG, Khuri SF, Mentzer RM Jr (2006) National Surgical Quality Improvement Program (NSQIP) risk factors can be used to validate American Society of Anesthesiologists Physical Status Classification (ASA PS) levels. Ann Surg 243(5):636–641 (discussion 641–634)

    Article  PubMed  PubMed Central  Google Scholar 

  32. Ahola R, Siiki A, Rinta-Kiikka I et al (2022) Preoperative measures predicting outcome after pancreatic resection in aged patients. Scand J Surg 111(1):14574969221083136

    Article  PubMed  Google Scholar 

  33. Badgwell B, Stanley J, Chang GJ et al (2013) Comprehensive geriatric assessment of risk factors associated with adverse outcomes and resource utilization in cancer patients undergoing abdominal surgery. J Surg Oncol 108(3):182–186

    Article  PubMed  Google Scholar 

  34. Khanh LN, Helenowski IB, Hoel AW, Ho KJ (2020) The comorbidity-polypharmacy score is an objective and practical predictor of outcomes and mortality after vascular surgery. Ann Vasc Surg 69:206–216

    Article  PubMed  Google Scholar 

  35. Stawicki SP, Kalra S, Jones C et al (2015) Comorbidity polypharmacy score and its clinical utility: a pragmatic practitioner’s perspective. J Emerg Trauma Shock 8(4):224–231

    Article  PubMed  PubMed Central  Google Scholar 

  36. Callery MP, Pratt WB, Kent TS, Chaikof EL, Vollmer CM Jr (2013) A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy. J Am Coll Surg 216(1):1–14

    Article  PubMed  Google Scholar 

  37. Lao M, Zhang X, Guo C et al (2020) External validation of alternative fistula risk score (a-FRS) for predicting pancreatic fistula after pancreatoduodenectomy. HPB 22(1):58–66

    Article  PubMed  Google Scholar 

  38. Mungroop TH, Klompmaker S, Wellner UF et al (2021) Updated alternative fistula risk score (ua-FRS) to include minimally invasive pancreatoduodenectomy: Pan-European validation. Ann Surg 273(2):334–340

    Article  PubMed  Google Scholar 

  39. van Dongen JC, Wismans LV, Suurmeijer JA et al (2021) The effect of preoperative chemotherapy and chemoradiotherapy on pancreatic fistula and other surgical complications after pancreatic resection: a systematic review and meta-analysis of comparative studies. HPB 23(9):1321–1331

    Article  PubMed  Google Scholar 

  40. Atema JJ, Jilesen APJ, Busch ORC, Van Gulik TM, Gouma DJ, Van Dijkum EJM (2015) Pancreatic fistulae after pancreatic resections for neuroendocrine tumours compared with resections for other lesions. HPB 17(1):38–45

    Article  PubMed  Google Scholar 

  41. Shen J, Zhang Y, Hu J, Wei R, Wu H (2020) Albumin difference as a new predictor of pancreatic fistula following distal pancreatectomy: a retrospective study of 211 consecutive patients. Langenbecks Arch Surg 405(1):55–62

    Article  PubMed  Google Scholar 

  42. Rungsakulkij N, Mingphruedhi S, Tangtawee P et al (2017) Risk factors for pancreatic fistula following pancreaticoduodenectomy: a retrospective study in a Thai tertiary center. World J Gastrointest Surg 9(12):270–280

    Article  PubMed  PubMed Central  Google Scholar 

  43. Timme S, Kayser G, Werner M et al (2021) Surgeon vs pathologist for prediction of pancreatic fistula: results from the randomized multicenter RECOPANC study. J Am Coll Surg 232(6):935–945

    Article  PubMed  Google Scholar 

  44. Casciani F, Trudeau MT, Asbun HJ et al (2021) The effect of high intraoperative blood loss on pancreatic fistula development after pancreatoduodenectomy: an international, multi-institutional propensity score matched analysis. Surgery 170(4):1195–1204

    Article  PubMed  Google Scholar 

  45. Niu CY, Ji B, Dai XL, Guan QC, Liu YH (2021) Use of alternative pancreatic fistula risk score system for patients with clinical relevant postoperative pancreatic fistula after laparoscopic pancreaticoduodenectomy. Zhonghua Wai Ke Za Zhi 59(7):631–635

    CAS  PubMed  Google Scholar 

  46. Piskin E, Oter V, Colakoglu MK, Ozgun YM, Aydin O, Bostanci EB (2022) Minimally invasive pancreaticoduodenectomy: similar morbidity and no mortality in the learning period. Sisli Etfal Hastan Tip Bul 56(2):238–243

    PubMed  PubMed Central  Google Scholar 

  47. Kawaida H, Kono H, Hosomura N et al (2019) Surgical techniques and postoperative management to prevent postoperative pancreatic fistula after pancreatic surgery. World J Gastroenterol 25(28):3722–3737

    Article  PubMed  PubMed Central  Google Scholar 

  48. Nahm CB, Alzaabi S, Sahni S, Gill AJ, Samra JS, Mittal A (2021) Increased postoperative pancreatic fistula rate after distal pancreatectomy compared with pancreatoduodenectomy is attributable to a difference in acinar scores. J Hepatobiliary Pancreat Sci 28(6):533–541

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. The Hiram C. Polk, Jr., MD, Division of Surgical Oncology, Department of Surgery, University of Louisville School of Medicine, Louisville, KY, 40292, USA

    Noah A. Clements, Prejesh Philips, Michael E. Egger, Kelly M. McMasters & Charles R. Scoggins

  2. Division of Surgical Oncology, Department of Surgery, University of Louisville School of Medicine, 315 E. Broadway, Louisville, KY, 40202, USA

    Robert C. G. Martin II

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Correspondence to Robert C. G. Martin II.

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Noah A. Clements, Prejesh Philips, Michael E. Egger, Kelly M. McMasters, Charles R. Scoggins, Robert C. G. Martin II have no conflicts of interest or financial ties to disclose.

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Clements, N.A., Philips, P., Egger, M.E. et al. Combined pre-operative risk score predicts pancreatic leak after pancreatic resection. Surg Endosc 38, 742–756 (2024). https://doi.org/10.1007/s00464-023-10602-z

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