A Rapid Predictive System for Pancreatic Fistula after Pancreaticoduodenectomy: A Report from a Low-Volume Center

Background: Postoperative pancreatic fistula (POPF) is a serious complication of pancreaticoduodenectomy (PD). Methods: We retrospectively reviewed the records of 109 consecutive patients who underwent PD between January 2006 and September 2015 in Saitama City Hospital. Preoperative and intraoperative variables were evaluated by univariate and multivariate logistic regression analyses to establish an immediate prediction model for POPF. Results: POPF grade A developed in 13 patients [12% (13/109)], grade B in 19 [17% (17/109)], and grade C in 3 [3% (3/109)]. Multivariate analysis demonstrated that the diameter of the main pancreatic duct (dMPD) ≤ 3.2 mm [odds ratio (OR) 4.26, 95% confidence intervals (CIs) 1.45-12.50, P=0.008], and operative times ≥ 425 min (OR 10.20, 95% CIs 2.67-39.00, P<0.001) were significant independent risk factors for POPF after PD. Using a combination of these two factors, the 109 patients were divided into two groups, and the incidence of POPF in patients with dMPD ≤ 3.2 mm and with operative times ≥ 425 min was significantly higher than in those without them both [62% (26/42) versus 13% (9/67), P<0.001]. The predictive accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were 77% (84/109), 74% (26/35), 78% (58/74), 62% (26/42), and 87% (58/67), respectively. Conclusions: Our predictive model of POPF after PD has high accuracy. The immediate ability to predict POPF after PD using our model results in better postoperative management of patients undergoing PD.