Use Of Alternative Pancreatic Fistula Risk Score System For Patients With Clinical Relevant Postoperative Pancreatic Fistula After Laparoscopic Pancreaticoduodenectomy

Objective:To discuss the use of alternative pancreatic fistula risk score system(a-FRS)for patients with clinically relevant postoperative pancreatic fistula(CR-POPF)after laparoscopic pancreaticoduodenectomy(LPD).Methods:The clinical data of 400 patients who underwent LPD at the department of Hepatobiliary and Pancreatic Surgery,Jilin University First Hospital,Changchun from April 2015 to August 2019 were retrospectively analyzed.There were 217 males and 183 females,with an average age of(58.6±10.9)years(range:26-93 years)and BMI of(23.0±2.7)kg/m~2(range:19.4-27.1 kg/m~2).Preoperative CA19-9 was(171.6±212.7)U/m L(range:32.1-762.6 U/ml),and preoperative CA125 was(18.6±22.9)U/ml(range:9.0-112.3 U/ml).Univariate analysis and multivariate logistic regression analysis were implemented to find the independent risk factors in CR-POPF.According to the three indicators of a-FRS system(pancreatic texture,main pancreatic duct diameter,and body mass index),the low risk group was defined as test negative group,the medium and high risk groups were defined as testing positive groups.ROC curve was used to prospectively analyze the clinical value of CR-POPF.Results:CR-POPF occurred in 60 patients(15.0%)of the 400 patients,including 54patients(13.5%)with grade B pancreatic fistula and 6 patients(1.5%)with grade C pancreatic fistula.Univariate and multivariate logistic regression analysis showed that soft pancreas,diameter of main pancreatic duct≤3 mm,and body mass index>23 kg/m~2were independent risk factors for CR-POPF after LPD(P<0.001,P<0.001,P=0.004).All the indicators in a-FRS system were statistically significant for predicting CR-POPF.The incidence of CR-POPF was 1.92%in the group with low pancreatic fistula risk(0-5%),5.88%with moderate pancreatic fistula risk(5%-20%),and 80.70%with high pancreatic fistula risk(>20%).a-FRS prospectively predicted the sensitivity and specificity of CR-POPF after LPD was 76.67%,96.76%,positive predictive value was 80.70%,negative predictive value was 95.92%,positive likelihood ratio was 23.66,negative likelihood ratio was 0.24,and area under the curve was 0.735(95%CI:0.668-0.799).Conclusion:The soft pancreas,diameter of main pancreatic duct≤3 mm,and body mass index>23 kg/m~2were independent risk factors for CR-POPF after LPD.The a-FRS system has great clinical application value in predicting CR-POPF after LPD,which can provide basis for early risk prediction of CR-POPF and timely related clinical intervention.