The Fistula Risk Score Catalog: Toward Precision Medicine for Pancreatic Fistula After Pancreatoduodenectomy By Springer

Objective: The aim of this study to present a full spectrum of individual presentations of pancreatic fistula risk patients, and to determine the utility of mitigation strategies among some of the most common and vulnerable scenario surgeon meeting.

Background: FRS has been used to identify technical strategies related to reducing the incidence of CR-POPF in various strata of risk. However, risk-stratification using the FRS not been investigated with greater granularity. By lowering all possible combinations of elements FRS, individual risk assessment can be used for medicinal purposes precision.

Methods: FRS profile and the results of the 5533 PD accrued from 17 international organizations (2003-2019). FRS is used to get 80 patients a unique combination of a “scenario.” risk-matched analysis was performed using a Bonferroni adjustment to identify the scenario with increased susceptibility to CR-POPF occurrence. Furthermore, these scenarios were analyzed using multivariable regression to explore the optimal mitigation approach.

Results: The overall rate of CR-POPF was 13.6%. All 80 scenarios that may be encountered, with the most frequent being the scenario # 1 (8.1%) – only negligible-risk scenario (level CR-POPF = 0.7%). Moderate-risk zone has the most scenario (50), patients (N = 3246), CR-POPFs (65.2%), and the largest non-zero-POPF CR rate differences between the scenarios (18-fold). In a risk-matched analysis, scenario 2 (# 59 and 60) displayed increased susceptibility to CR-POPF relative to moderate-risk zones (both P <0.001). Multivariate analysis revealed that factors associated with CR-POPF in this scenario: pancreaticogastrostomy reconstruction [odds ratio (OR) 4.67], negligence drain placement (OR 5.51), and octreotide prophylaxis (OR 3.09).

When comparing the utilization of best practice strategies for patients who do not have these jointly exploited, there is a significant reduction in CR-POPF (10.7% vs 35.5%, P <0.001; OR 0.20, 95% confidence interval 0, 12-.33).
Conclusion: Through this data, the risk of fistula comprehensive catalog has been created and the most clinical scenario-impact has been seen. Focusing on individual scenario provides a practical way for the treatment of precision approach, allowing for more focused management and efficient CR-POPF.