Ellis Ryan J, Brock Hewitt D, Liu Jason B, Cohen Mark E, Merkow Ryan P, Bentrem David J, Bilimoria Karl Y, Yang Anthony D
Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, Illinois.
Department of Surgery, Surgical Outcomes and Quality Improvement Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
J Surg Oncol. 2019 Jun;119(8):1128-1134. doi: 10.1002/jso.25464. Epub 2019 Apr 5.
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.
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.
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).
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.
胰瘘仍然很常见，术前对患者进行风险分层的能力有限。本研究的目的是确定术前常规可用的与临床相关的术后胰瘘（CR-POPF）的危险因素。
使用国家临床登记系统检查2014年至2017年所有胰十二指肠切除术术前可用的变量。该队列被分为危险因素识别亚组和内部验证亚组。
在15033例胰十二指肠切除术中，CR-POPF发生率为16.7%。男性患者（比值比[OR]，1.51）、肥胖患者（体重指数[BMI]＞30，OR，1.97）、术前体重减轻极少的患者（OR，1.25）、胰管未扩张的患者（OR，1.81）、无糖尿病的患者（OR，1.80）、未接受新辅助治疗的患者（OR，1.78）、无胆道梗阻证据的患者（OR，1.18）或非腺癌病理的患者（OR,1.96；均P＜0.01）发生CR-POPF的可能性更高。有三个或更少危险因素的患者CR-POPF发生率为7.1%，而有六个或更多危险因素的患者CR-POPF发生率为26.3%（P＜0.001）。
术前CR-POPF风险评估可能是患者咨询和手术规划中的一个有用工具，风险评估可能有助于就围手术期管理做出更明智的决策，包括强化康复方案和生长抑素类似物的使用。
