Risk factors and risk prediction of pancreatic fistula after pancreaticoduodenectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WU Nai , ZHANG Pengbo ,  REN Zeqiang

Department of Pancreatic Surgery, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221000, P. R. China;

Corresponding author：

REN Zeqiang, Email: rzq0805@189.cn

Keywords：

pancreaticoduodenectomy; pancreatic fistula; risk factor; risk prediction

DOI：

10.7507/1007-9424.201708054

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To summarize risk factors of pancreatic fistula after pancreaticoduodenectomy and to investigate clinical application of pancreatic fistula risk prediction system. Method The literatures of the risk factors and risk prediction of pancreatic fistula after the pancreaticoduodenectomy were collected to make a review. Results There were many risk factors for pancreatic fistula after pancreatoduodenectomy, including the patient’s own factors (gender, age, underlying diseases, etc.), disease related factors (pancreatic texture, diameter of pancreatic duct, pathological type, etc.), and surgical related factors (operation time, intraoperative blood loss, anastomosis, pancreatic duct drainage, etc.). The fistula risk prediction system after the pancreatoduodenectomy had a better forecast accuracy. Conclusions Occurrence of pancreatic fistula after pancreaticoduodenectomy is related to softness of pancreas and small diameter of pancreatic duct. Pancreatic fistula risk prediction system is helpful for prevention of pancreatic fistula after pancreaticoduodenectomy.

Citation： WU Nai, ZHANG Pengbo, REN Zeqiang. Risk factors and risk prediction of pancreatic fistula after pancreaticoduodenectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(7): 889-894. doi: 10.7507/1007-9424.201708054 Copy

1.	McMillan MT, Vollmer CM Jr. Predictive factors for pancreatic fistula following pancreatectomy. Langenbecks Arch Surg, 2014, 399(7): 811-824.
2.	Malleo G, Vollmer CM Jr. Postpancreatectomy complications and management. Surg Clin North Am, 2016, 96(6): 1313-1336.
3.	DeOliveira ML, Winter JM, Schafer M, et al. Assessment of complications after pancreatic surgery: A novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann Surg, 2006, 244(6): 931-939.
4.	Bassi C, Marchegiani G, Dervenis C, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery, 201, 161(3): 584-591.
5.	Vollmer CM Jr, Sanchez N, Gondek S, et al. A root-cause analysis of mortality following major pancreatectomy. J Gastrointest Surg, 2012, 16(1): 89-103.
6.	Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery, 2005, 138(1): 8-13.
7.	Büchler MW, Wagner M, Schmied BM, et al. Changes in morbidity after pancreatic resection: toward the end of completion pancreatectomy. Arch Surg, 2003, 138(12): 1310-1315.
8.	Lermite E, Sommacale D, Piardi T, et al. Complications after pancreatic resection: diagnosis, prevention and management.Clin Res Hepatol Gastroenterol, 2013, 37(3): 230-239.
9.	Kamoda Y, Fujino Y, Matsumoto I, et al. Usefulness of performing a pancreaticojejunostomy with an internal stent after a pancreatoduodenectomy. Surg Today, 2008, 38(6): 524-528.
10.	Veillette G, Dominguez I, Ferrone C, et al. Implications and management of pancreatic fistulas following pancreaticoduodenectomy: the Massachusetts General Hospital experience. Arch Surg, 2008, 143(5): 476-481.
11.	Lin JW, Cameron JL, Yeo CJ, et al. Risk factors and outcomes in postpancreaticoduodenectomy pancreaticocutaneous fistula. J Gastrointest Surg, 2004, 8(8): 951-959.
12.	Hu BY, Wan T, Zhang WZ, et al. Risk factors for postoperative pancreatic fistula: Analysis of 539 successive cases of pancreaticoduodenectomy. World J Gastroenterol, 2016, 22(34): 7797-7805.
13.	Matsusue S, Takeda H, Nakamura Y, et al. A prospective analysis of the factors influencing pancreaticojejunostomy performed using a single method, in 100 consecutive pancreaticoduodenectomies. Surg Today, 1998, 28(7): 719-726.
14.	Choe YM, Lee KY, Oh CA, et al. Risk factors affecting pancreatic fistulas after pancreaticoduodenectomy. World J Gastroenterol, 2008, 14(45): 6970-6974.
15.	Noun R, Riachy E, Ghorra C, et al. The impact of obesity on surgical outcome after pancreaticoduodenectomy. JOP, 2008, 9(4): 468-476.
16.	Williams TK, Rosato EL, Kennedy EP, et al. Impact of obesity on perioperative morbidity and mortality after pancreaticoduodenectomy. J Am Coll Surg, 2009, 208(2): 210-217.
17.	Lermite E, Pessaux P, Brehant O, et al. Risk factors of pancreatic fistula and delayed gastric emptying after pancreaticoduodenectomy with pancreaticogastrostomy. J Am Coll Surg, 2007, 204(4): 588-596.
18.	DeOliveira ML, Winter JM, Schafer M, et al. Assessment of complications after pancreatic surgery: A novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann Surg, 2006, 244(6): 931-939.
19.	Satoi S, Takai S, Matsui Y, et al. Less morbidity after pancreaticoduodenectomy of patients with pancreatic cancer. Pancreas, 2006, 33(1): 45-52.
20.	Cheng Q, Zhang B, Zhang Y, et al. Predictive factors for complications after pancreaticoduodenectomy. J Surg Res, 2007, 139(1): 22-29.
21.	Pratt WB, Callery MP, Vollmer CM Jr. Risk prediction for development of pancreatic fistula using the ISGPF classification scheme. World J Surg, 2008, 32(3): 419-428.
22.	de Castro SM, Busch OR, van Gulik TM, et al. Incidence and management of pancreatic leakage after pancreatoduodenectomy. Br J Surg, 2005, 92(9): 1117-1123.
23.	Veillette G, Dominguez I, Ferrone C, et al. Implications and management of pancreatic fistulas following pancreaticoduodenectomy: the Massachusetts General Hospital experience. Arch Surg, 2008, 143(5): 476-481.
24.	Rosso E, Casnedi S, Pessaux P, et al. The role of "fatty pancreas" and of BMI in the occurrence of pancreatic fistula after pancreaticoduodenectomy. J Gastrointest Surg, 2009, 13(10): 1845-1851.
25.	Belyaev O, Rosenkranz S, Munding J, et al. Quantitative assessment and determinants of suture-holding capacity of human pancreas. J Surg Res, 2013, 184(2): 807-812.
26.	Mikamori M, Gotoh K, Takahashi H, et al. Novel intraoperative use of the " Tensipresser” to assess factors predictive of pancreatic fistula after pancreaticoduodenectomy. Surg Today, 2017 Mar 21. doi: 10.1007/s00595-017-1509-7. [Epub ahead of print].
27.	Sugimoto M, Takahashi S, Kojima M, et al. What is the nature of pancreatic consistency? Assessment of the elastic modulus of the pancreas and comparison with tactile sensation, histology, and occurrence of postoperative pancreatic fistula after pancreaticoduodenectomy. Surgery, 2014, 156(5): 1204-1211.
28.	Harada N, Yoshizumi T, Maeda T, et al. Preoperative pancreatic stiffness by real-time tissue elastography to predict pancreatic fistula after pancreaticoduodenectomy. Anticancer Res, 2017, 37(4): 1909-1915.
29.	Poon RT, Fan ST, Lo CM, et al. External drainage of pancreatic duct with a stent to reduce leakage rate of pancreaticojejunostomy after pancreaticoduodenectomy: a prospective randomized trial. Ann Surg, 2007, 246(3): 425-433.
30.	Liu QY, Zhang WZ, Xia HT, et al. Analysis of risk factors for postoperative pancreatic fistula following pancreaticoduodenectomy. World J Gastroenterol, 2014, 20(46): 17491-17497.
31.	Peng SY, Mou YP, Liu Y B, et al. Binding pancreaticojejunostomy: 150 consecutive cases without leakage. J Gastrointest Surg, 2003, 7(7): 898-900.
32.	Yang YM, Tian XD, Zhuang Y, et al. Risk factors of pancreatic leakage after pancreaticoduodenectomy. World J Gastroenterol, 2005, 11(16): 2456-2461.
33.	Xu J, Zhang B, Shi S, et al. Papillary-like main pancreatic duct invaginated pancreaticojejunostomy versus duct-to-mucosa pancreaticojejunostomy after pancreaticoduodenectomy: A prospective randomized trial. Surgery, 2015, 158(5): 1211-1218.
34.	Straja ND, Daha C, Brătucu E, et al. Pancreaticojejunostomy—Risk anastomosis after cephalic pancreaticoduodenectomy. Chirurgia (Bucur), 2015, 110(4): 339-345.
35.	Tani M, Kawai M, Hirono S, et al. Randomized clinical trial of isolated Roux-en-Y versus conventional reconstruction after pancreaticoduodenectomy. Br J Surg, 2014, 101(9): 1084-1091.
36.	Heeger K, Fendrich V, Waldmann J, et al. Reduced complication rate after modified binding purse-string-mattress sutures pancreatogastrostomy versus duct-to-mucosa pancreaticojejunostomy. Surgeon, 2013, 11(5): 246-252.
37.	Guerrini GP, Soliani P, D'Amico G, et al. Pancreaticojejunostomy versus pancreaticogastrostomy after pancreaticoduodenectomy: an up-to-date meta-analysis. J Invest Surg, 2016, 29(3): 175-184.
38.	Keck T, Wellner UF, Bahra M, et al. Pancreatogastrostomy versus pancreatojejunostomy for reconstruction after pancreatoduodenectomy (RECOPANC, DRKS 00000767): Perioperative and long-term results of a multicenter randomized controlled trial. Ann Surg, 2016, 263(3): 440-449.
39.	Rault A, Sa Cunha A, Klopfenstein D, et al. Pancreaticojejunal anastomosis is preferable to pancreaticogastrostomy after pancreaticoduodenectomy for longterm outcomes of pancreatic exocrine function. J Am Coll Surg, 2005, 201(2): 239-244.
40.	Mok KT, Wang BW. Management of pancreatic remnant with strategies according to the size of pancreatic duct after pancreaticoduodenectomy. Br J Surg, 1999, 86(8): 1018-1019.
41.	Pessaux P, Sauvanet A, Mariette C, et al. External pancreatic duct stent decreases pancreatic fistula rate after pancreaticoduodenectomy: prospective multicenter randomized trial. Ann Surg, 2011, 253(5): 879-885.
42.	Roder JD, Stein HJ, Böttcher KA, et al. Stented versus nonstented pancreaticojejunostomy after pancreatoduodenectomy: a prospective study. Ann Surg,1999, 229(1): 41-48.
43.	Hong S,Wang H,Yang S. External stent versus no stent for pancreaticojejunostomy: a meta-analysis of randomized controlled trials. J Gastrointest Surg, 2013, 17(8): 1516-1525.
44.	Motoi F, Egawa S, Rikiyama T, et al. Randomized clinical trial of external stent drainage of the pancreatic duct to reduce postoperative pancreatic fistula after pancreaticojejunostomy. Br J Surg, 2012, 99(4): 524-531.
45.	Dong Z, Xu J, Wang Z, et al. Stents for the prevention of pancreatic fistula following pancreaticoduodenectomy. Cochrane Database Syst Rev, 2016, (5): CD008914.
46.	Palani Velu LK, Chandrabalan VV, Jabbar S, et al. Serum amylase on the night of surgery predicts clinically significant pancreatic fistula after pancreaticoduodenectomy. HPB (Oxford), 2014, 16(7): 610-619.
47.	Yang J, Huang Q, Wang C. Postoperative drain amylase predicts pancreatic fistula in pancreatic surgery: A systematic review and meta-analysis. Int J Surg, 2015, 22: 38-45.
48.	Lippi G, Valentino M, Cervellin G. Laboratory diagnosis of acute pancreatitis: in search of the Holy Grail. Crit Rev Clin Lab Sci, 2012, 49(1): 18-31.
49.	Dalla Valle R, De Bellis M, Pedrazzi G, et al. Can early serum lipase measurement be routinely implemented to rule out clinically significant pancreatic fistula after pancreaticoduodenectomy? Int J Surg, 2015, 21 Suppl 1: S50-S54.
50.	De Schryver N, Wittebole X, Hubert C, et al. Early hyperlactatemia predicts pancreatic fistula after surgery. BMC Anesthesiol, 2015, 15: 109.
51.	Sandini M, Bernasconi DP, Ippolito D, et al. Preoperative Computed Tomography to Predict and Stratify the Risk of Severe Pancreatic Fistula After Pancreatoduodenectomy. Medicine (Baltimore), 2015, 94(31): e1152.
52.	Yardimci S, Kara YB, Tuney D, et al. A simple method to evaluate whether pancreas texture can be used to predict pancreatic fistula risk after pancreatoduodenectomy. J Gastrointest Surg, 2015, 19(9): 1625-1631.
53.	Tranchart H, Gaujoux S, Rebours V, et al. Preoperative CT scan helps to predict the occurrence of severe pancreatic fistula after pancreaticoduodenectomy. Ann Surg, 2012, 256(1): 139-145.
54.	Callery MP, Pratt WB, Kent TS, et al. A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy. J Am Coll Surg, 2013, 216(1): 1-14.
55.	Yamamoto Y, Sakamoto Y, Nara S, et al. A preoperative predictive scoring system for postoperative pancreatic fistula after pancreaticoduodenectomy. World J Surg, 2011, 35(12): 2747-2755.
56.	Wellner UF, Kayser G, Lapshyn H, et al. A simple scoring system based on clinical factors related to pancreatic texture predicts postoperative pancreatic fistula preoperatively. HPB (Oxford), 2010, 12(10): 696-702.
57.	Chen JY, Feng J, Wang XQ, et al. Risk scoring system and predictor for clinically relevant pancreatic fistula after pancreaticoduodenectomy. World J Gastroenterol, 2015, 21(19): 5926-5933.

1. McMillan MT, Vollmer CM Jr. Predictive factors for pancreatic fistula following pancreatectomy. Langenbecks Arch Surg, 2014, 399(7): 811-824.
2. Malleo G, Vollmer CM Jr. Postpancreatectomy complications and management. Surg Clin North Am, 2016, 96(6): 1313-1336.
3. DeOliveira ML, Winter JM, Schafer M, et al. Assessment of complications after pancreatic surgery: A novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann Surg, 2006, 244(6): 931-939.
4. Bassi C, Marchegiani G, Dervenis C, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery, 201, 161(3): 584-591.
5. Vollmer CM Jr, Sanchez N, Gondek S, et al. A root-cause analysis of mortality following major pancreatectomy. J Gastrointest Surg, 2012, 16(1): 89-103.
6. Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery, 2005, 138(1): 8-13.
7. Büchler MW, Wagner M, Schmied BM, et al. Changes in morbidity after pancreatic resection: toward the end of completion pancreatectomy. Arch Surg, 2003, 138(12): 1310-1315.
8. Lermite E, Sommacale D, Piardi T, et al. Complications after pancreatic resection: diagnosis, prevention and management.Clin Res Hepatol Gastroenterol, 2013, 37(3): 230-239.
9. Kamoda Y, Fujino Y, Matsumoto I, et al. Usefulness of performing a pancreaticojejunostomy with an internal stent after a pancreatoduodenectomy. Surg Today, 2008, 38(6): 524-528.
10. Veillette G, Dominguez I, Ferrone C, et al. Implications and management of pancreatic fistulas following pancreaticoduodenectomy: the Massachusetts General Hospital experience. Arch Surg, 2008, 143(5): 476-481.
11. Lin JW, Cameron JL, Yeo CJ, et al. Risk factors and outcomes in postpancreaticoduodenectomy pancreaticocutaneous fistula. J Gastrointest Surg, 2004, 8(8): 951-959.
12. Hu BY, Wan T, Zhang WZ, et al. Risk factors for postoperative pancreatic fistula: Analysis of 539 successive cases of pancreaticoduodenectomy. World J Gastroenterol, 2016, 22(34): 7797-7805.
13. Matsusue S, Takeda H, Nakamura Y, et al. A prospective analysis of the factors influencing pancreaticojejunostomy performed using a single method, in 100 consecutive pancreaticoduodenectomies. Surg Today, 1998, 28(7): 719-726.
14. Choe YM, Lee KY, Oh CA, et al. Risk factors affecting pancreatic fistulas after pancreaticoduodenectomy. World J Gastroenterol, 2008, 14(45): 6970-6974.
15. Noun R, Riachy E, Ghorra C, et al. The impact of obesity on surgical outcome after pancreaticoduodenectomy. JOP, 2008, 9(4): 468-476.
16. Williams TK, Rosato EL, Kennedy EP, et al. Impact of obesity on perioperative morbidity and mortality after pancreaticoduodenectomy. J Am Coll Surg, 2009, 208(2): 210-217.
17. Lermite E, Pessaux P, Brehant O, et al. Risk factors of pancreatic fistula and delayed gastric emptying after pancreaticoduodenectomy with pancreaticogastrostomy. J Am Coll Surg, 2007, 204(4): 588-596.
18. DeOliveira ML, Winter JM, Schafer M, et al. Assessment of complications after pancreatic surgery: A novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann Surg, 2006, 244(6): 931-939.
19. Satoi S, Takai S, Matsui Y, et al. Less morbidity after pancreaticoduodenectomy of patients with pancreatic cancer. Pancreas, 2006, 33(1): 45-52.
20. Cheng Q, Zhang B, Zhang Y, et al. Predictive factors for complications after pancreaticoduodenectomy. J Surg Res, 2007, 139(1): 22-29.
21. Pratt WB, Callery MP, Vollmer CM Jr. Risk prediction for development of pancreatic fistula using the ISGPF classification scheme. World J Surg, 2008, 32(3): 419-428.
22. de Castro SM, Busch OR, van Gulik TM, et al. Incidence and management of pancreatic leakage after pancreatoduodenectomy. Br J Surg, 2005, 92(9): 1117-1123.
23. Veillette G, Dominguez I, Ferrone C, et al. Implications and management of pancreatic fistulas following pancreaticoduodenectomy: the Massachusetts General Hospital experience. Arch Surg, 2008, 143(5): 476-481.
24. Rosso E, Casnedi S, Pessaux P, et al. The role of "fatty pancreas" and of BMI in the occurrence of pancreatic fistula after pancreaticoduodenectomy. J Gastrointest Surg, 2009, 13(10): 1845-1851.
25. Belyaev O, Rosenkranz S, Munding J, et al. Quantitative assessment and determinants of suture-holding capacity of human pancreas. J Surg Res, 2013, 184(2): 807-812.
26. Mikamori M, Gotoh K, Takahashi H, et al. Novel intraoperative use of the " Tensipresser” to assess factors predictive of pancreatic fistula after pancreaticoduodenectomy. Surg Today, 2017 Mar 21. doi: 10.1007/s00595-017-1509-7. [Epub ahead of print].
27. Sugimoto M, Takahashi S, Kojima M, et al. What is the nature of pancreatic consistency? Assessment of the elastic modulus of the pancreas and comparison with tactile sensation, histology, and occurrence of postoperative pancreatic fistula after pancreaticoduodenectomy. Surgery, 2014, 156(5): 1204-1211.
28. Harada N, Yoshizumi T, Maeda T, et al. Preoperative pancreatic stiffness by real-time tissue elastography to predict pancreatic fistula after pancreaticoduodenectomy. Anticancer Res, 2017, 37(4): 1909-1915.
29. Poon RT, Fan ST, Lo CM, et al. External drainage of pancreatic duct with a stent to reduce leakage rate of pancreaticojejunostomy after pancreaticoduodenectomy: a prospective randomized trial. Ann Surg, 2007, 246(3): 425-433.
30. Liu QY, Zhang WZ, Xia HT, et al. Analysis of risk factors for postoperative pancreatic fistula following pancreaticoduodenectomy. World J Gastroenterol, 2014, 20(46): 17491-17497.
31. Peng SY, Mou YP, Liu Y B, et al. Binding pancreaticojejunostomy: 150 consecutive cases without leakage. J Gastrointest Surg, 2003, 7(7): 898-900.
32. Yang YM, Tian XD, Zhuang Y, et al. Risk factors of pancreatic leakage after pancreaticoduodenectomy. World J Gastroenterol, 2005, 11(16): 2456-2461.
33. Xu J, Zhang B, Shi S, et al. Papillary-like main pancreatic duct invaginated pancreaticojejunostomy versus duct-to-mucosa pancreaticojejunostomy after pancreaticoduodenectomy: A prospective randomized trial. Surgery, 2015, 158(5): 1211-1218.
34. Straja ND, Daha C, Brătucu E, et al. Pancreaticojejunostomy—Risk anastomosis after cephalic pancreaticoduodenectomy. Chirurgia (Bucur), 2015, 110(4): 339-345.
35. Tani M, Kawai M, Hirono S, et al. Randomized clinical trial of isolated Roux-en-Y versus conventional reconstruction after pancreaticoduodenectomy. Br J Surg, 2014, 101(9): 1084-1091.
36. Heeger K, Fendrich V, Waldmann J, et al. Reduced complication rate after modified binding purse-string-mattress sutures pancreatogastrostomy versus duct-to-mucosa pancreaticojejunostomy. Surgeon, 2013, 11(5): 246-252.
37. Guerrini GP, Soliani P, D'Amico G, et al. Pancreaticojejunostomy versus pancreaticogastrostomy after pancreaticoduodenectomy: an up-to-date meta-analysis. J Invest Surg, 2016, 29(3): 175-184.
38. Keck T, Wellner UF, Bahra M, et al. Pancreatogastrostomy versus pancreatojejunostomy for reconstruction after pancreatoduodenectomy (RECOPANC, DRKS 00000767): Perioperative and long-term results of a multicenter randomized controlled trial. Ann Surg, 2016, 263(3): 440-449.
39. Rault A, Sa Cunha A, Klopfenstein D, et al. Pancreaticojejunal anastomosis is preferable to pancreaticogastrostomy after pancreaticoduodenectomy for longterm outcomes of pancreatic exocrine function. J Am Coll Surg, 2005, 201(2): 239-244.
40. Mok KT, Wang BW. Management of pancreatic remnant with strategies according to the size of pancreatic duct after pancreaticoduodenectomy. Br J Surg, 1999, 86(8): 1018-1019.
41. Pessaux P, Sauvanet A, Mariette C, et al. External pancreatic duct stent decreases pancreatic fistula rate after pancreaticoduodenectomy: prospective multicenter randomized trial. Ann Surg, 2011, 253(5): 879-885.
42. Roder JD, Stein HJ, Böttcher KA, et al. Stented versus nonstented pancreaticojejunostomy after pancreatoduodenectomy: a prospective study. Ann Surg,1999, 229(1): 41-48.
43. Hong S,Wang H,Yang S. External stent versus no stent for pancreaticojejunostomy: a meta-analysis of randomized controlled trials. J Gastrointest Surg, 2013, 17(8): 1516-1525.
44. Motoi F, Egawa S, Rikiyama T, et al. Randomized clinical trial of external stent drainage of the pancreatic duct to reduce postoperative pancreatic fistula after pancreaticojejunostomy. Br J Surg, 2012, 99(4): 524-531.
45. Dong Z, Xu J, Wang Z, et al. Stents for the prevention of pancreatic fistula following pancreaticoduodenectomy. Cochrane Database Syst Rev, 2016, (5): CD008914.
46. Palani Velu LK, Chandrabalan VV, Jabbar S, et al. Serum amylase on the night of surgery predicts clinically significant pancreatic fistula after pancreaticoduodenectomy. HPB (Oxford), 2014, 16(7): 610-619.
47. Yang J, Huang Q, Wang C. Postoperative drain amylase predicts pancreatic fistula in pancreatic surgery: A systematic review and meta-analysis. Int J Surg, 2015, 22: 38-45.
48. Lippi G, Valentino M, Cervellin G. Laboratory diagnosis of acute pancreatitis: in search of the Holy Grail. Crit Rev Clin Lab Sci, 2012, 49(1): 18-31.
49. Dalla Valle R, De Bellis M, Pedrazzi G, et al. Can early serum lipase measurement be routinely implemented to rule out clinically significant pancreatic fistula after pancreaticoduodenectomy? Int J Surg, 2015, 21 Suppl 1: S50-S54.
50. De Schryver N, Wittebole X, Hubert C, et al. Early hyperlactatemia predicts pancreatic fistula after surgery. BMC Anesthesiol, 2015, 15: 109.
51. Sandini M, Bernasconi DP, Ippolito D, et al. Preoperative Computed Tomography to Predict and Stratify the Risk of Severe Pancreatic Fistula After Pancreatoduodenectomy. Medicine (Baltimore), 2015, 94(31): e1152.
52. Yardimci S, Kara YB, Tuney D, et al. A simple method to evaluate whether pancreas texture can be used to predict pancreatic fistula risk after pancreatoduodenectomy. J Gastrointest Surg, 2015, 19(9): 1625-1631.
53. Tranchart H, Gaujoux S, Rebours V, et al. Preoperative CT scan helps to predict the occurrence of severe pancreatic fistula after pancreaticoduodenectomy. Ann Surg, 2012, 256(1): 139-145.
54. Callery MP, Pratt WB, Kent TS, et al. A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy. J Am Coll Surg, 2013, 216(1): 1-14.
55. Yamamoto Y, Sakamoto Y, Nara S, et al. A preoperative predictive scoring system for postoperative pancreatic fistula after pancreaticoduodenectomy. World J Surg, 2011, 35(12): 2747-2755.
56. Wellner UF, Kayser G, Lapshyn H, et al. A simple scoring system based on clinical factors related to pancreatic texture predicts postoperative pancreatic fistula preoperatively. HPB (Oxford), 2010, 12(10): 696-702.
57. Chen JY, Feng J, Wang XQ, et al. Risk scoring system and predictor for clinically relevant pancreatic fistula after pancreaticoduodenectomy. World J Gastroenterol, 2015, 21(19): 5926-5933.

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Risk factors and risk prediction of pancreatic fistula after pancreaticoduodenectomy

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