Callery et al developed a Fistula Risk Score for identifying a patient at risk for a pancreatic fistula following pancreatoduodenectomy. This can help to identify a patient who may benefit from more aggressive management. The authors are from Deaconess Medical Center, Barnes Jewish Hospital (St. Louis) and the Hospital of the University of Pennsylvania.
Patient selection: pancreatoduodenectomy
Parameters:
(1) pancreatic texture
(2) underlying pathology
(3) diameter of the pancreatic duct in mm
(4) intra-operative blood loss in mL
|
Parameter |
Finding |
Points |
|
pancreatic texture |
firm |
0 |
|
|
soft |
2 |
|
underlying pathology |
pancreatitis |
0 |
|
|
pancreatic adenocarcinoma |
0 |
|
|
other tumor (cystic, islet cell, duodenal, ampullary) |
1 |
|
pancreatic duct diameter |
>= 5 mm |
0 |
|
|
4 mm |
1 |
|
|
3 mm |
2 |
|
|
2 mm |
3 |
|
|
<= 1 mm |
4 |
|
intraoperative blood loss |
<= 400 mL |
0 |
|
|
401 to 700 mL |
1 |
|
|
701 to 1,000 mL |
2 |
|
|
> 1,000 mL |
3 |
total score =
= SUM(points for all 4 parameters)
Interpretation:
• minimum score: 0
• maximum score: 10
• The higher the score the greater the risk of a clinically relevant postoperative pancreatic fistula.
|
Total Score |
Risk Group |
Percent |
|
0 |
very low |
< 1% |
|
1 or 2 |
low |
3-5% |
|
3 to 6 |
intermediate |
10 to 30% |
|
7 or 8 |
high risk |
67 to 80% |
|
9 or 10 |
very high risk |
100% |
Specialty: Gastroenterology, Surgery, general
