Ann Surg Treat Res.  2022 Dec;103(6):340-349. 10.4174/astr.2022.103.6.340.

Utility of fistula risk score in assessing the risk of postoperative pancreatic fistula occurrence and other significant complications after different types of pancreatic neuroendocrine tumor resections

• Molasy B
• Zemła P
• Mrowiec S
• Kusnierz K

• KMID: 2536910
• DOI: http://doi.org/10.4174/astr.2022.103.6.340

Abstract

Purpose
This study was performed to evaluate the utility of the fistula risk score (FRS) and its components in predicting the occurrence of postoperative pancreatic fistula and other significant postoperative complications after resections of pancreatic neuroendocrine tumors.
Methods
Retrospective analysis of 131 patients operated on for pancreatic neuroendocrine tumors between 2015 and 2021 was performed. The correlation of the FRS scale with the occurrence of postoperative pancreatic fistulas and postoperative complications according to the Clavien-Dindo classification was analyzed; only in 109 cases of distal resections and pancreatoduodenectomies (PD).
Results
Soft pancreatic texture and intraoperative blood loss of >700 mL are risk factors for clinically significant pancreatic fistula (P = 0.001 and P = 0.001, respectively) and significant postoperative complications (P = 0.016 and P = 0.001, respectively). Wirsung duct diameter (WDD) was associated only with the occurrence of postoperative pancreatic fistula (P = 0.013). FRS scale is associated with the occurrence of pancreatic fistulas and clinically significant postoperative complications in cases of distal resections and PDs (P < 0.001 and P = 0.005, respectively). Postoperative complications are correlated with the occurrence of fistula type B or C (P < 0.001).
Conclusion
Soft pancreatic texture, intraoperative blood loss of >700 mL, and a WDD of ≤3 mm are risk factors for clinically significant postoperative pancreatic fistula. FRS may be applied not only in PDs but also in distal pancreatectomies. Unfortunately, it is not used in total pancreatic resections and enucleations since FRS takes into account the WDD.

Keyword

Complications; Neuroendocrine tumors; Pancreatic fistula; Pancreatectomy; Pancreatic ducts

Figure

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  Fig. 1 Forest plot regarding multivariate binary regression analysis of the influence of different risk factors on the manifestation of postoperative pancreatic fistula. OR, odds ratio; CI, confidence interval.

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  Fig. 2 Forest plot regarding multivariate binary regression analysis of the influence of different risk factors on complications according to Clavien-Dindo classification after performed surgery. OR, odds ratio; CI, confidence interval.

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