Preoperative risk evaluation for pancreatic fistula after pancreaticoduodenectomy

Ryan J. Ellis, D. Brock Hewitt, Jason B. Liu, Mark E. Cohen, Ryan Patrick Merkow, David Jason Bentrem, Karl Y Bilimoria, Anthony D Yang*

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Background: Pancreatic fistula remains common, with limited ability to risk stratify patients preoperatively. The objective of this study was to identify risk factors for clinically-relevant postoperative pancreatic fistula (CR-POPF) that are routinely available in the preoperative setting. Methods: Preoperatively available variables for all pancreaticoduodenectomies from 2014-2017 were examined using a national clinical registry. The cohort was separated into risk factor identification and internal validation subgroups. Results: Among 15 033 pancreaticoduodenectomies, the CR-POPF rate was 16.7%. CR-POPF was more likely in patients that were male (odds ratio [OR], 1.51), obese (body mass index [BMI] > 30, OR, 1.97), had minimal preoperative weight loss (OR, 1.25), had a nondilated pancreatic duct (OR, 1.81), did not have diabetes, (OR, 1.80), did not receive neoadjuvant therapy (OR, 1.78), had no evidence of biliary obstruction (OR, 1.18), or had nonadenocarcinoma pathology (OR, 1.96; all P < 0.01). Patients with three or fewer risk factors had a CR-POPF rate of 7.1%, while those with six or more risk factors had a CR-POPF rate of 26.3% (P < 0.001). Conclusion: Preoperative CR-POPF risk evaluation could be a useful tool in patient counseling and surgical planning, and risk may allow for more well-informed decisions regarding perioperative management, including enhanced recovery protocols and use of somatostatin analogs.

Original languageEnglish (US)
Pages (from-to)1128-1134
Number of pages7
JournalJournal of surgical oncology
Volume119
Issue number8
DOIs
StatePublished - Jun 15 2019

Fingerprint

Pancreatic Fistula
Pancreaticoduodenectomy
Odds Ratio
Aptitude
Neoadjuvant Therapy
Pancreatic Ducts
Somatostatin
Registries
Counseling
Weight Loss
Body Mass Index
Pathology

Keywords

  • Whipple procedure
  • pancreatic fistula
  • pancreatic surgery
  • pancreaticoduodenectomy

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

@article{3291ee1d7db94e3ab1b0e2d7c5f14148,
title = "Preoperative risk evaluation for pancreatic fistula after pancreaticoduodenectomy",
abstract = "Background: Pancreatic fistula remains common, with limited ability to risk stratify patients preoperatively. The objective of this study was to identify risk factors for clinically-relevant postoperative pancreatic fistula (CR-POPF) that are routinely available in the preoperative setting. Methods: Preoperatively available variables for all pancreaticoduodenectomies from 2014-2017 were examined using a national clinical registry. The cohort was separated into risk factor identification and internal validation subgroups. Results: Among 15 033 pancreaticoduodenectomies, the CR-POPF rate was 16.7{\%}. CR-POPF was more likely in patients that were male (odds ratio [OR], 1.51), obese (body mass index [BMI] > 30, OR, 1.97), had minimal preoperative weight loss (OR, 1.25), had a nondilated pancreatic duct (OR, 1.81), did not have diabetes, (OR, 1.80), did not receive neoadjuvant therapy (OR, 1.78), had no evidence of biliary obstruction (OR, 1.18), or had nonadenocarcinoma pathology (OR, 1.96; all P < 0.01). Patients with three or fewer risk factors had a CR-POPF rate of 7.1{\%}, while those with six or more risk factors had a CR-POPF rate of 26.3{\%} (P < 0.001). Conclusion: Preoperative CR-POPF risk evaluation could be a useful tool in patient counseling and surgical planning, and risk may allow for more well-informed decisions regarding perioperative management, including enhanced recovery protocols and use of somatostatin analogs.",
keywords = "Whipple procedure, pancreatic fistula, pancreatic surgery, pancreaticoduodenectomy",
author = "Ellis, {Ryan J.} and {Brock Hewitt}, D. and Liu, {Jason B.} and Cohen, {Mark E.} and Merkow, {Ryan Patrick} and Bentrem, {David Jason} and Bilimoria, {Karl Y} and Yang, {Anthony D}",
year = "2019",
month = "6",
day = "15",
doi = "10.1002/jso.25464",
language = "English (US)",
volume = "119",
pages = "1128--1134",
journal = "Journal of Surgical Oncology",
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}

Preoperative risk evaluation for pancreatic fistula after pancreaticoduodenectomy. / Ellis, Ryan J.; Brock Hewitt, D.; Liu, Jason B.; Cohen, Mark E.; Merkow, Ryan Patrick; Bentrem, David Jason; Bilimoria, Karl Y; Yang, Anthony D.

In: Journal of surgical oncology, Vol. 119, No. 8, 15.06.2019, p. 1128-1134.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Preoperative risk evaluation for pancreatic fistula after pancreaticoduodenectomy

AU - Ellis, Ryan J.

AU - Brock Hewitt, D.

AU - Liu, Jason B.

AU - Cohen, Mark E.

AU - Merkow, Ryan Patrick

AU - Bentrem, David Jason

AU - Bilimoria, Karl Y

AU - Yang, Anthony D

PY - 2019/6/15

Y1 - 2019/6/15

N2 - Background: Pancreatic fistula remains common, with limited ability to risk stratify patients preoperatively. The objective of this study was to identify risk factors for clinically-relevant postoperative pancreatic fistula (CR-POPF) that are routinely available in the preoperative setting. Methods: Preoperatively available variables for all pancreaticoduodenectomies from 2014-2017 were examined using a national clinical registry. The cohort was separated into risk factor identification and internal validation subgroups. Results: Among 15 033 pancreaticoduodenectomies, the CR-POPF rate was 16.7%. CR-POPF was more likely in patients that were male (odds ratio [OR], 1.51), obese (body mass index [BMI] > 30, OR, 1.97), had minimal preoperative weight loss (OR, 1.25), had a nondilated pancreatic duct (OR, 1.81), did not have diabetes, (OR, 1.80), did not receive neoadjuvant therapy (OR, 1.78), had no evidence of biliary obstruction (OR, 1.18), or had nonadenocarcinoma pathology (OR, 1.96; all P < 0.01). Patients with three or fewer risk factors had a CR-POPF rate of 7.1%, while those with six or more risk factors had a CR-POPF rate of 26.3% (P < 0.001). Conclusion: Preoperative CR-POPF risk evaluation could be a useful tool in patient counseling and surgical planning, and risk may allow for more well-informed decisions regarding perioperative management, including enhanced recovery protocols and use of somatostatin analogs.

AB - Background: Pancreatic fistula remains common, with limited ability to risk stratify patients preoperatively. The objective of this study was to identify risk factors for clinically-relevant postoperative pancreatic fistula (CR-POPF) that are routinely available in the preoperative setting. Methods: Preoperatively available variables for all pancreaticoduodenectomies from 2014-2017 were examined using a national clinical registry. The cohort was separated into risk factor identification and internal validation subgroups. Results: Among 15 033 pancreaticoduodenectomies, the CR-POPF rate was 16.7%. CR-POPF was more likely in patients that were male (odds ratio [OR], 1.51), obese (body mass index [BMI] > 30, OR, 1.97), had minimal preoperative weight loss (OR, 1.25), had a nondilated pancreatic duct (OR, 1.81), did not have diabetes, (OR, 1.80), did not receive neoadjuvant therapy (OR, 1.78), had no evidence of biliary obstruction (OR, 1.18), or had nonadenocarcinoma pathology (OR, 1.96; all P < 0.01). Patients with three or fewer risk factors had a CR-POPF rate of 7.1%, while those with six or more risk factors had a CR-POPF rate of 26.3% (P < 0.001). Conclusion: Preoperative CR-POPF risk evaluation could be a useful tool in patient counseling and surgical planning, and risk may allow for more well-informed decisions regarding perioperative management, including enhanced recovery protocols and use of somatostatin analogs.

KW - Whipple procedure

KW - pancreatic fistula

KW - pancreatic surgery

KW - pancreaticoduodenectomy

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