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

• Published in: Surgical endoscopy Vol. 38; no. 2; pp. 742 - 756
• Main Authors: Clements, Noah A., Philips, Prejesh, Egger, Michael E., McMasters, Kelly M., Scoggins, Charles R., Martin, Robert C. G.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.02.2024; Springer Nature B.V
• Subjects: Abdominal Surgery; Blood platelets; Body mass index; Comorbidity; Endoscopy; Fistula; Gastroenterology; Gynecology; Hepatology; Humans; Magnetic resonance imaging; Medical personnel; Medicine; Medicine & Public Health; Mortality; Oncology; Pancreas - surgery; Pancreatectomy - adverse effects; Pancreatic Fistula - diagnosis; Pancreatic Fistula - epidemiology; Pancreatic Fistula - etiology; Pancreaticoduodenectomy - adverse effects; Patients; Polypharmacy; Postoperative Complications - diagnosis; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Proctology; Retrospective Studies; Risk Factors; Surgery; Surgical outcomes; Comorbidity-polypharmacy score; Pancreatic resection; Main pancreatic duct diameter; Pancreatectomy; Prediction; Complication; Fistula; Pancreaticoduodenectomy; Pancreas
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-023-10602-z

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.