Pancreatic fistula risk factors
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
According to Fistula Risk Scoring (FRS) system, the risk factors for the development of pancreatic fistula depends upon the texture of the gland, underlying pathology, diameter of the pancreatic duct, underlying carcinoma involving the pancreatic duct, intraoperative blood loss and other risk factors such as male gender, obesity, malnutrition, increase gland remnant volume, fasting blood glucose level <108 mg/dl and excessive fluid administration during surgery.
Risk Factors
Common Risk Factors
According to Fistula Risk Scoring (FRS) system, the risk factors for the development of pancreatic fistula depends upon:
- Texture of the gland: Soft texture of the gland is identified as a predictive risk factor.
- Pathology: Carcinoma of the duodenum, ampulla, cystic duct and islet cell carries high risk for fistula development compared to the glandular carcinoma such as pancreatic ductal adenocarcinoma or chronic pancreatitis.
- Diameter of the pancreatic duct: Small pancreatic duct diameter <3mm is identified as a risk factor for the development of fistula formation, specifically a diameter of <1mm carries a high risk.
- Intraoperative blood loss: >1000ml is associated with a high risk of fistula formation.[1]
Less Common Risk Factors
- Less common risk factors in the development of pancreatic fistula include:
- Male gender
- Excessive fluid administration during surgery,
- Fasting blood glucose <108 mg/dl and an increase remnant gland volume.
- Some studies have reported both malnutrition and obesity as risk factors for the development of pancreatic cancer.[2][3]
References
- ↑ Nahm CB, Connor SJ, Samra JS, Mittal A (2018). "Postoperative pancreatic fistula: a review of traditional and emerging concepts". Clin Exp Gastroenterol. 11: 105–118. doi:10.2147/CEG.S120217. PMC 5858541. PMID 29588609.
- ↑ Ke Z, Cui J, Hu N, Yang Z, Chen H, Hu J; et al. (2018). "Risk factors for postoperative pancreatic fistula: Analysis of 170 consecutive cases of pancreaticoduodenectomy based on the updated ISGPS classification and grading system". Medicine (Baltimore). 97 (35): e12151. doi:10.1097/MD.0000000000012151. PMC 6392812. PMID 30170457.
- ↑ Martin AN, Narayanan S, Turrentine FE, Bauer TW, Adams RB, Zaydfudim VM (2018). "Pancreatic duct size and gland texture are associated with pancreatic fistula after pancreaticoduodenectomy but not after distal pancreatectomy". PLoS One. 13 (9): e0203841. doi:10.1371/journal.pone.0203841. PMC 6136772. PMID 30212577.