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Multidimensional Nomogram to Predict Postoperative Pancreatic Fistula after Minimally Invasive Pancreaticoduodenectomy

  • Pancreatic Tumors
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Clinically relevant postoperative pancreatic fistula (CR-POPF) is an inherently severe risk of pancreatic resection. Previous research has proposed models that identify risk factors and predict CR-POPF, although these are rarely applicable to minimally invasive pancreaticoduodenectomy (MIPD). This study aimed to evaluate the individual risks of CR-POPF and to propose a nomogram for predicting POPF in MIPD.

Patients and Methods

We retrospectively reviewed the medical records of 429 patients who underwent MIPD. In the multivariate analysis, the Akaike information criterion stepwise logistic regression method was used to select the final model to develop the nomogram.


Of 429 patients, 53 (12.4%) experienced CR-POPF. On multivariate analysis, pancreatic texture (p = 0.001), open conversion (p = 0.008), intraoperative transfusion (p = 0.011), and pathology (p = 0.048) were identified as independent predictors of CR-POPF. The nomogram was developed based on patient, pancreatic, operative, and surgeon factors by using the following four additional clinical factors as variables: American Society of Anesthesiologists class ≥ III, size of pancreatic duct, type of surgical approach, and < 40 cases of MIPD experience.


A multidimensional nomogram was developed to predict CR-POPF after MIPD. This nomogram and calculator can help surgeons anticipate, select, and manage critical complications.

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Authors and Affiliations



MC acquired the data and drafted the manuscript. HY and JYJ acquired the data. JHL and RYH analyzed and interpreted the data. SHC and JHL revised the manuscript and agreed with the manuscript’s results and conclusions. CMK supervised the study and gave final approval to the manuscript.

Corresponding authors

Correspondence to Sung Hoon Choi MD or Chang Moo Kang MD, PhD.

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The authors declare no conflicts of interest for this article.

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Asan Medical Center, S2020-1498-0001. Severance Hospital, 0201-05-039. CHA Bundang Medical Center, 2021-0002-001.

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Choi, M., Lee, J.H., Roh, Y.H. et al. Multidimensional Nomogram to Predict Postoperative Pancreatic Fistula after Minimally Invasive Pancreaticoduodenectomy. Ann Surg Oncol 30, 5083–5090 (2023).

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