Adjusted ISGPS model enhances prediction of pancreatic fistulas.

The study validated the ISGPS classification to predict clinically relevant pancreatic fistula (CRPF) risk in 1,422 patients undergoing pancreatoduodenectomy for periampullary tumors. The CRPF rate was 22.2%, with a higher rate of 25.8% for periampullary tumors. Although the original ISGPS model showed moderate performance (AUC=0.632), the adjusted model demonstrated improved discrimination for periampullary tumors with an AUC of 0.672. Key predictors included soft pancreas, BMI ≥23 kg/m², and pancreatic duct size ≤3 mm.