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Multidimensional Nomogram to Predict Postoperative Pancreatic Fistula after Minimally Invasive Pancreaticoduodenectomy

Authors
 Munseok Choi  ;  Jae Hoon Lee  ;  Yun Ho Roh  ;  Hyeyeon Kim  ;  Jae Young Jang  ;  Sung Hoon Choi  ;  Chang Moo Kang 
Citation
 ANNALS OF SURGICAL ONCOLOGY, Vol.30(8) : 5083-5090, 2023-08 
Journal Title
ANNALS OF SURGICAL ONCOLOGY
ISSN
 1068-9265 
Issue Date
2023-08
MeSH
Humans ; Nomograms ; Pancreas / surgery ; Pancreatic Fistula* / diagnosis ; Pancreatic Fistula* / etiology ; Pancreaticoduodenectomy* / adverse effects ; Pancreaticoduodenectomy* / methods ; Postoperative Complications / pathology ; Retrospective Studies ; Risk Factors
Abstract
Background: Clinically relevant postoperative pancreatic fistula (CR-POPF) is an inherently severe risk of pancreatic resection. Previous research has proposed models that identify risk factors and predict CR-POPF, although these are rarely applicable to minimally invasive pancreaticoduodenectomy (MIPD). This study aimed to evaluate the individual risks of CR-POPF and to propose a nomogram for predicting POPF in MIPD.



Patients and methods: We retrospectively reviewed the medical records of 429 patients who underwent MIPD. In the multivariate analysis, the Akaike information criterion stepwise logistic regression method was used to select the final model to develop the nomogram.



Results: Of 429 patients, 53 (12.4%) experienced CR-POPF. On multivariate analysis, pancreatic texture (p = 0.001), open conversion (p = 0.008), intraoperative transfusion (p = 0.011), and pathology (p = 0.048) were identified as independent predictors of CR-POPF. The nomogram was developed based on patient, pancreatic, operative, and surgeon factors by using the following four additional clinical factors as variables: American Society of Anesthesiologists class ≥ III, size of pancreatic duct, type of surgical approach, and < 40 cases of MIPD experience.



Conclusions: A multidimensional nomogram was developed to predict CR-POPF after MIPD. This nomogram and calculator can help surgeons anticipate, select, and manage critical complications.
Full Text
https://link.springer.com/article/10.1245/s10434-023-13360-3
DOI
10.1245/s10434-023-13360-3
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Chang Moo(강창무) ORCID logo https://orcid.org/0000-0002-5382-4658
Roh, Yun Ho(노윤호)
Choi, Munseok(최문석) ORCID logo https://orcid.org/0000-0002-9844-4747
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/196165
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