Seoung Yoon Rho, MD, Jae Uk Jung, MD, Ho Kyoung Hwang, MD, Chang Moo Kang, MD, Woo Jung Lee, MD. Yonsei University
Background: Despite the technological advancement of a minimally invasive approach to Pylorus –preserving pancreaticoduodenectomy (PPPD), the morbidity is still high. Among the many complications, postoperative pancreatic fistula (POPF) is reported in high incidence rate, which varies from researcher to researcher, and a fistula risk score(FRS) has been developed to predict the POPF. The aim of this study is validate the fistula risk score in minimally invasive approach of PPPD and find the other meaningful parameter for prediction of POPF.
Method and materials: From January 2008 to August 2017, laparoscopy attempted right-sided pancreas resection was performed on 142 patients including robotic reconstruction in the Division of Hepatobiliary and pancreas at Yonsei University Health System. Among them, 43 patients were excluded due to total pancreatectomy (N=15), open conversion (N=12), pancreaticogastrostomy and hybrid manual anastomosis (N=12), non-measurable drain and missing datas (N=4). POPF grade was defined as revised 2016 International Study Group of Pancreatic Fistula.
Results: Among the total patients (N=99), POPF were 51 (51.5%). Biochemical leak were 39 (39.4%) and Grade B was 9 (9.1%), Grade C was 3 (3.0%). FRS 6 was 29 patients and FRS 3 (N=19), FRS 5(N=14), FRS 1 (N=12). 67 patients were Moderate risk (FRS 3-6) group and 15 patients in low risk group (FRS 1-2), 13 patients in high risk (FRS 7-10), 4 patients in negligible risk (FRS 0). In POPF C, 3 moderate risk patients were included. In POPF B, 8 patients of moderate risk and only one patient in high risk were included. In Biochemical leak, 31 moderate risk patients and 7 high risk patients, 1 low risk patient were included. In univariate analysis of POPF (biochemical leak, B and C), soft gland texture ( OR 19.056 , 95% CI 4.149-87.526, p value 0.000 ) , pancreatic duct size (OR 0.809 , 95% CI 0.677-0.966, p-value 0.019) and FRS (OR 1.526, 95% CI 1.228-1.897, p-value 0.000) were statistically significant. In multivariate analysis of Clinically relavant POPF (POPF B, C), body mass index(BMI) was statistically significant (adjusted OR 1.367, 95% CI 1.035-1.806, p-value 0.028). Area under curve(AUC) of BMI was 0.676 in Receiver operating characteristic(ROC) curve (p-value 0.049).
Conclusions: Fistula risk score is significant prediction factor of POPF including biochemical leaks. In addition to the previously known FRS variables, our data showed that BMI is an important predictor of POPF with clinical relavancy in a minimally invasive approach of PPPD.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86636
Program Number: P513
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster