Validation of the Updated Alternate Fistula Risk Score for Prediction of Postoperative Pancreatic Fistula After Pancreatoduodenectomy

Abstract

Background and Aim

Postoperative pancreatic fistula (POPF) remains a significant challenge following pancreatoduodenectomy (PD), contributing to morbidity and mortality. Various risk assessment models have been established to predict the likelihood of POPF. An updated alternate fistula risk score (ua-FRS) has been recently refined and validated within European cohorts. However, the validation of this score in South Asian cohorts remains relatively unexplored. This study aims to validate the applicability of ua-FRS for the prediction of POPF in patients undergoing PD in the South Asian population, particularly Nepal.

Methods

This cross-sectional, observational study was conducted by a single team across three tertiary care centers in Kathmandu, Nepal from July 2021 to October 2023. A total of 98 patients were studied in terms of their sex, body mass index (BMI), diameter of the main pancreatic duct (MPD), pancreatic consistency, pathological site, and estimated blood loss. The accuracy of ua-FRS for the prediction of postoperative pancreatic fistula after pancreatoduodenectomy was evaluated using the receiver operative characteristics curve.

Results

Univariate analysis revealed that sex, pancreatic gland texture, the diameter of the main pancreatic duct, the site of pathology, and BMI were statistically significant factors. However, in the multivariate analysis, only BMI and the diameter of the MPD retained their statistical significance, with p-values less than 0.005. The ua-FRS demonstrated high sensitivity and specificity in predicting postoperative pancreatic fistula, as evidenced by an area under the curve (AUC) of 0.802.

Conclusion

The ua-FRS has validation in the context of the South Asian population to predict POPF following PD, offering a reliable tool to guide perioperative management.