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Background/Purpose: Postoperative pancreatic fistula (POPF) is a serious complication of pancreaticoduodenectomy and current predictors of POPF are inadequate. We developed a new fistula score to more accurately predict POPF. Methods: We retrospectively reviewed 169 patients who underwent pancreaticoduodenectomy between January 2010 and August 2021 at our institution and examined patients' risk factors according to the occurrence of grade B/C POPF. Muscle and fat were assessed on preoperative computed tomography images and cutoff values were determined by receiver operating characteristic curve analysis. Results: Grade B/C POPF occurred in 38 (22.5%) patients. Multivariate analysis of patients' risk factors revealed that sarcopenic obesity (odds ratio [OR] 2.94; p =.033), L3 subcutaneous fat area (SFA) ≥ 98.0 cm2 (OR 2.69; p =.049), and soft pancreatic texture (OR 27.5; p =.002) were independent risk factors of grade B/C POPF occurrence. In addition, a new fistula risk score based on these factors revealed that 63.6% of patients with high scores developed grade B/C POPF, while those with negligible or low scores did not. Conclusions: A new fistula risk scoring system based on sarcopenic obesity, SFA, and pancreatic texture may accurately predict POFP. [ABSTRACT FROM AUTHOR]

A 78-year-old male patient came to our hospital with a chief complaint of fever. Computed tomography revealed an indistinct tumor in the pancreatic head, along with dilatation of the bile duct and main pancreatic duct. An endoscopic transpapillary biopsy demonstrated adenocarcinoma in the glandular epithelium and a dense formation of quasi-round cells. Pathology results indicated positive CK AE1/AE3 and INSM-1, negative CD45, and a Ki67 index of about 80%, leading to a diagnosis of neuroendocrine carcinoma (NEC) Grade 3 of the pancreatic head. Consequently, a pancreatoduodenectomy was performed. Postoperative pathology revealed small cell NEC (SCNEC) at the pancreatic head, with infiltrative growth of atypical gland ducts around the bile ducts, indicating the presence of a well-differentiated adenocarcinoma. The adenocarcinoma contained in situ lesions and biliary intraepithelial neoplasia (BilIN), with SCNEC being contiguous. Therefore, the diagnosis was NEC originating from the extrahepatic bile duct, which invaded the pancreatic head. NEC of the extrahepatic bile duct is rare, accounting for approximately 0.2-2% of gastrointestinal neuroendocrine tumors, and it has a poor prognosis, similar to other gastrointestinal NECs, even when surgical treatment is performed. The patient remained an outpatient without recurrence 17 months postoperatively.

Background/purpose: Postoperative pancreatic fistula (POPF) is a serious complication of pancreaticoduodenectomy and current predictors of POPF are inadequate. We developed a new fistula score to more accurately predict POPF., Methods: We retrospectively reviewed 169 patients who underwent pancreaticoduodenectomy between January 2010 and August 2021 at our institution and examined patients' risk factors according to the occurrence of grade B/C POPF. Muscle and fat were assessed on preoperative computed tomography images and cutoff values were determined by receiver operating characteristic curve analysis., Results: Grade B/C POPF occurred in 38 (22.5%) patients. Multivariate analysis of patients' risk factors revealed that sarcopenic obesity (odds ratio [OR] 2.94; p = .033), L3 subcutaneous fat area (SFA) ≥ 98.0 cm 2 (OR 2.69; p = .049), and soft pancreatic texture (OR 27.5; p = .002) were independent risk factors of grade B/C POPF occurrence. In addition, a new fistula risk score based on these factors revealed that 63.6% of patients with high scores developed grade B/C POPF, while those with negligible or low scores did not., Conclusions: A new fistula risk scoring system based on sarcopenic obesity, SFA, and pancreatic texture may accurately predict POFP., (© 2022 Japanese Society of Hepato-Biliary-Pancreatic Surgery.)