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A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy.

Published on Jan 1, 2013in Journal of The American College of Surgeons4.45
· DOI :10.1016/j.jamcollsurg.2012.09.002
Mark P. Callery48
Estimated H-index: 48
(BIDMC: Beth Israel Deaconess Medical Center),
Wande B. Pratt17
Estimated H-index: 17
(WashU: Washington University in St. Louis)
+ 2 AuthorsCharles M. Vollmer40
Estimated H-index: 40
(UPenn: University of Pennsylvania)
Sources
Abstract
Background Clinically relevant postoperative pancreatic fistulas (CR-POPF) are serious inherent risks of pancreatic resection. Preoperative CR-POPF risk assessment is currently inadequate and rarely disqualifies patients who need resection. The best evaluation of risk occurs intraoperatively, and should guide fistula prevention and response measures thereafter. We sought to develop a risk prediction tool for CR-POPF that features intraoperative assessment and reveals associated clinical and economic significance. Study Design Based on International Study Group of Pancreatic Fistula classification, recognized risk factors for CR-POPF (small duct, soft pancreas, high-risk pathology, excessive blood loss) were evaluated during pancreaticoduodenectomy. An optimal risk score range model, selected from 3 different constructs, was first derived (n = 233) and then validated prospectively (n = 212). Clinical and economic outcomes were evaluated across 4 ranges of scores (negligible risk, 0 points; low risk, 1 to 2; intermediate risk, 3 to 6; high risk, 7 to 10). Results Clinically relevant postoperative pancreatic fistulas occurred in 13% of patients. The incidence was greatest with excessive blood loss. Duct size Conclusions A simple 10-point Fistula Risk Score derived during pancreaticoduodenectomy accurately predicts subsequent CR-POPF. It can be readily learned and broadly deployed. This prediction tool can help surgeons anticipate, identify, and manage this ominous complication from the outset.
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References40
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#1Charles M. Vollmer (Harvard University)H-Index: 40
#2Norberto Sanchez (Harvard University)H-Index: 4
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#2Teviah Sachs (BIDMC: Beth Israel Deaconess Medical Center)H-Index: 13
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#2Jens Werner (Heidelberg University)H-Index: 45
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Objective:The purpose of this study was to determine whether patients who develop a pancreatic fistula after pancreatoduodenectomy are more likely to have higher pancreatic fat levels than matched controls and if so, to investigate whether preoperative dual gradient-echo magnetic resonance (MR) imag
60 CitationsSource
#1Mark P. Callery (Harvard University)H-Index: 48
#2Wande B. Pratt (Harvard University)H-Index: 17
Last. Charles M. Vollmer (Harvard University)H-Index: 40
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Despite significant improvements in the safety and efficacy of pancreatic surgery, post-operative pancreatic fistulae remain an unsolved dilemma. These occur when the transected pancreatic gland, pancreatic-enteric anastomosis, or both, leak rendering the patient at significant risk. They are especially important today since indications for resection (IPMN, carcinoma) continue to increase. This review considers definitions and classifications of pancreatic fistulae, risk factors, preventative ap...
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#1Hironori HayashiH-Index: 13
#2Koji AmayaH-Index: 3
Last. Atsushi HiroseH-Index: 3
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Summary Background Postoperative pancreatic fistula (POPF) after pancreatoduodenectomy greatly influences patients' postoperative course. Several evaluation methods have been used to assess the risk of clinically relevant POPF (CR-POPF) after pancreatoduodenectomy namely, the original, alternative, and updated alternative fistula risk scores (o-FRS, a-FRS, and ua-FRS, respectively). Methods We enrolled 106/179 patients who underwent pancreatoduodenectomy in our institution between April 2013 and...
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#2Dipesh Kumar Yadav (ZJU: Zhejiang University)H-Index: 1
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Clinically relevant postoperative pancreatic fistula (CR-POPF) is the considerable contributor to major complications after pancreatectomy. The purpose of this study was to evaluate the potential risk factor contributing to CR-POPF following distal pancreatectomy (DP) and discussed the risk factors of pancreatic fistula in order to interpret the clinical importance. All the patients who underwent DP in between January 2011 and January 2020 were reviewed retrospectively in accordance with relevan...
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#1Bofeng Chen (UPenn: University of Pennsylvania)H-Index: 2
#2Maxwell T. Trudeau (UPenn: University of Pennsylvania)
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Background Hyperbilirubinemia is commonly observed in patients requiring pancreatoduodenectomy (PD). Thus far, literature regarding the danger of operating in the setting of hyperbilirubinemia is equivocal. What remains undefined is at what specific level of bilirubin there is an adverse safety profile for undergoing PD. The aim of this study is to identify the optimal safety profile of patients with hyperbilirubinemia undergoing PD.
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BACKGROUND: Postoperative pancreatic fistula (POPF) is the most serious complication following pancreaticoduodenectomy (PD). Identifying patients at high or low risk of developing POPF is important in perioperative management. This study aimed to determine a predictive risk score for POPF following PD, and compare it to preexisting scores. METHODS: All patients who underwent open PD from 2012 to 2017 in two high-volume centers were included. The training dataset was used for the development of t...
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Background: Although mortality and morbidity of pancreatoduodenectomy (PD) have improved significantly over the past years, the impact of age for patients undergoing PD is still debated. This study is aimed at analyzing short- and long-term outcomes of PD in elderly patients. Methods: 124 consecutive patients who have undergone PD for pancreas neoplasms in our center between 2012 and 2017 were analyzed. Patients were divided into two groups: group I ( /=75 years). Demographic features and intrao...
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#1Charles Vanbrugghe (AMU: Aix-Marseille University)
#2David Jérémie Birnbaum (AMU: Aix-Marseille University)H-Index: 5
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PURPOSE: We evaluated the intuition of expert pancreatic surgeons, in predicting the associated risk of pancreatic resection and compared this "intuition" to actual operative follow-up. The objective was to avoid major complications following pancreatic resection, which remains a challenge. METHODS: From January 2015 to February 2018, all patients who were 18 years old or more undergoing a pancreatic resection (pancreaticoduodenectomy [PD], distal pancreatectomy [DP], or central pancreatectomy [...
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#1Stefano Partelli (UniSR: Vita-Salute San Raffaele University)H-Index: 29
#2Domenico Tamburrino (Sapienza University of Rome)H-Index: 13
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Abstract Background Postoperative acute pancreatitis (POAP) can be a possible cause of postoperative pancreatic fistula (POPF). The present study aimed to evaluate the role of clinically-relevant POAP (CR-POAP), defined according to different cut-offs of postoperative amylase (AMS) values and C-reactive protein (CRP), in the development of clinically relevant POPF (CR-POPF) after pancreaticoduodenectomy (PD). Methods Data from 610 patients who underwent PD (2015–2018) were analyzed. Patients wer...
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