Predictive factors for pancreatic fistula following pancreatectomy

Postoperative pancreatic fistula is a significant contributor to morbidity following proximal and distal pancreatic resections. In recent decades, the incidence of fistula has ranged from 2 to 33 %; however, the consistent identification of risk factors has been difficult due to significant variability in the definition of pancreatic fistula. The purpose of this study was to use the highest level evidence available in the literature to present risk factors thus far identified as significant predictors of fistula occurrence. Another endpoint will address those risk factors which have been shown to have a clinical impact on the patient. This review will conclude by discussing comprehensive risk models that interpret the aggregate fistula risk for a patient based on the presence of weighted risk factors. The contemporary surgical literature suggests many risk factors for fistula development, which can be categorized as either endogenous, operative, or perioperative. The advent of the International Study Group of Pancreatic Fistula (ISGPF) scheme created universal definitions for fistula that delineate between biochemical and clinically relevant fistulas. This classification system has allowed for the elucidation of risk factors for clinically impactful fistula and enabled the development of risk scores for predicting fistula occurrence after major pancreatic resections, which are useful in clinical management and comparative research.