Validation of original and alternative fistula risk scores in postoperative pancreatic fistula

Background In 2013, the fistula risk score (FRS) was developed to assess the risk of clinically relevant postoperative pancreatic fistula (CR-POPF). In 2017, the alternative FRS (a-FRS) was proposed. The purpose of this study was to validate the original FRS (o-FRS) and a-FRS for CR-POPF in pancreaticoduodenectomy (PD). Methods From January 2007 to December 2016, 1,771 patients underwent PD for periampullary cancers. POPF was defined and classified according to the 2016 International Study Group for Pancreatic Fistula. All data were reviewed retrospectively. Results Pathologic diagnosis other than ductal adenocarcinoma (P < 0.001), pancreas duct diameter (P < 0.001), and body mass index (P < 0.001) were independent risk factors for CR-POPF. Pancreatic texture (P = 0.534) and estimated blood loss (P = 0.827) were not associated with CR-POPF. The CR-POPF incidence increased with increasing o-FRS score (P < 0.001), and also increased statistically significantly with increasing a-FRS in the higher risk group (P < 0.001). However, the correlations differed. The area under the curve was 0.629 for o-FRS and 0.622 for a-FRS. Conclusions Both o-FRS and a-FRS might reflect CR-POPF incidence, but some risk factors had no or low statistical significance. Further research is needed to revise the FRS.