HPB SO78 - A Novel Application of ISGPS Guidelines for Calculating Pancreatic Fistula Rates Post-Distal Pancreatectomy

Abstract Background Post-operative pancreatic fistula (POPF) remains a major cause of morbidity and mortality following distal pancreatectomy and there is continual debate regarding the optimal peri-operative practice. The impact of drain displacement on outcome is poorly understood and limited information is documented on how the ISGPS guidelines are used to determine a clinically significant POPF. This study aims to assess the POPF and drain displacement rate at our institution and identify factors predicting a clinically significant POPF. We have proposed an algorithm to standardise the interpretation of the ISGPS guidelines. Method Case records of patients undergoing left sided pancreatectomy at our institution from January 2019 to January 2024 were analysed to assess the incidence of biochemical and clinically significant POPF using ISGPS criteria. Post operative CT scans were reviewed to record drain displacement with respect to the pancreatic stump. Continuous data was represented as mean +/- SD or median(IQR) depending on normality. Appropriate statistical tests were used for comparison of continuous and categorical variables (alfa error of 5%). Receiver operating characteristic curves were performed to assess the suitability of drain fluid amylase level as a predictor of clinically significant POPF. Results A total of 56 patients qualified for analysis. There was no difference between the clinically insignificant and significant groups with respect to age, gender, BMI, pathology and surgical technique (open/laparoscopic, splenic preservation, stump reinforcement). The clinically significant group had higher day three and peak drain amylase levels. The day of peak drain amylase was significantly later in this group. The drain displacement rate was 41% and did not differ significantly between the two groups. A day 3 drain fluid amylase level of 1120(U/L) had a 74% sensitivity of predicting a clinically significant POPF. Conclusion The ISGPS guidelines do not provide explicit criteria for stratifying the grade of POPF. We propose an algorithm to standardise the interpretation of these guidelines. Drain displacement did not impact POPF rate allowing for small sample size. Day 3 fluid amylase level is a useful predictor of clinically significant POPF. Program permission yes