# Predicting pancreatic fistulas after pancreatoduodenectomy: development and internal validation of a new preoperative nomogram

## TL;DR

A new preoperative tool predicts the risk of pancreatic fistulas after a specific type of surgery, using factors like gender, BMI, and pancreatic duct size.

## Contribution

Development and validation of a novel preoperative nomogram for predicting pancreatic fistulas after pancreatoduodenectomy.

## Key findings

- Male gender, higher BMI, and pancreatic duct ≤ 3 mm are risk factors for pancreatic fistulas.
- Preoperative weight loss > 10% is protective against fistula development.
- The nomogram achieved strong predictive accuracy with an AUC of 0.798.

## Abstract

•A preoperative nomogram predicts Pancreatic Fistula (PF) after pancreatoduodenectomy.•Risk factors for PF: male gender, BMI, and pancreatic duct ≤ 3 mm.•Weight loss > 10 % is protective against PF development.•The nomogram shows strong predictive accuracy (AUC = 0.798).

A preoperative nomogram predicts Pancreatic Fistula (PF) after pancreatoduodenectomy.

Risk factors for PF: male gender, BMI, and pancreatic duct ≤ 3 mm.

Weight loss > 10 % is protective against PF development.

The nomogram shows strong predictive accuracy (AUC = 0.798).

Pancreatic Fistula (PF) is a major complication following Pancreatoduodenectomy (PD), making its prediction crucial for individualized treatment. The aim of this study is to develop a preoperative nomogram to predict PF after PD.

From January 2009 to January 2018, patients who underwent PD were reviewed. Variables with p < 0.1 from univariate analysis were selected for a multivariate analysis. Variables with p < 0.05 were then included in the nomogram, which was internally validated in a different group of patients.

262 patients underwent PD during the period of the study. The risk factors for PF identified in the derivation group were male gender (OR = 2.89), higher BMI (OR = 1.14) and pancreatic duct diameter ≤ 3 mm (OR = 3.52). Preoperative weight loss exceeding 10 % within six months was protective against PF (OR = 0.16). A preoperative nomogram incorporating these four variables was developed and demonstrated good performance in the validation set, with an area under the ROC curve of 0.798.

male gender, a main pancreatic duct ≤ 3 mm and higher BMI are risk factors for PF, while weight loss is protective. The developed nomogram accurately predicts PF occurrence using these variables.