Clinical calculator summary
Original 2013 Callery Model III Fistula Risk Score
Clinical calculator summary
Original 2013 Callery Model III Fistula Risk Score
A 0-10 additive intraoperative score using gland texture, pathology, duct diameter, and blood loss.
Evidence-based context for fast calculator use
- Purpose:
- Reproduce the original CR-POPF risk-zone classification without converting historical cohort incidence into an individualized probability or management instruction.
- Population:
- Patients undergoing pancreaticoduodenectomy assessed intraoperatively in the original derivation and prospective-validation cohorts.
- Factors:
- Gland texture, Pathology group, Main pancreatic duct diameter, Intraoperative blood loss
- Reference:
- Callery et al. J Am Coll Surg. 2013;216(1):1-14. doi:10.1016/j.jamcollsurg.2012.09.002.
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Fistula Risk Score (FRS)
mL
Clinical Context & Background
This calculator reproduces the original 2013 Callery Model III Fistula Risk Score. It uses four intraoperative findings during pancreaticoduodenectomy: gland texture, pathology, main pancreatic duct diameter at the transection margin, and estimated blood loss.
The total ranges from 0 to 10 and maps to the original negligible, low, intermediate, and high risk zones. The percentages shown are clinically relevant postoperative pancreatic fistula (CR-POPF) incidences observed in the prospective validation cohort under the original ISGPF grade B/C definition.
This is not a preoperative calculator and is not established here for distal or total pancreatectomy. Historical cohort incidence is not an individualized probability and the score does not recommend drain placement or removal, anastomotic technique, prophylaxis, reoperation, or treatment.
Formula Logic
Original 2013 Callery Model III Fistula Risk Score: firm/soft gland 0/2; pancreatic adenocarcinoma or chronic pancreatitis 0, ampullary/duodenal/cystic/islet-cell pathology 1; duct >=5/4/3/2/<=1 mm scores 0/1/2/3/4; blood loss <=400/>400-700/>700-1000/>1000 mL scores 0/1/2/3.Reference Data
| Risk Zone | FRS Score | Prospective-cohort CR-POPF incidence |
|---|---|---|
| Negligible Risk | 0 | 0% |
| Low Risk | 1-2 | 6% |
| Intermediate Risk | 3-6 | 22% |
| High Risk | 7-10 | 88% |
Clinical Workflow
Use, Interpret, And Continue The Patient Pathway
Expand for workflow guidance, limitations, examples, and related next steps.
Clinical Workflow
Use, Interpret, And Continue The Patient Pathway
Expand for workflow guidance, limitations, examples, and related next steps.
When To Use
- Use intraoperatively during pancreaticoduodenectomy after all four source predictors are available.
- Measure the main pancreatic duct at the transection margin and enter raw unrounded blood loss in mL.
How To Interpret
- Add the four Model III point contributions to obtain a score from 0 to 10.
- Map the score to the original negligible, low, intermediate, or high risk zone.
- Treat the displayed CR-POPF percentage as a historical prospective-cohort observation.
What To Do Next
- Interpret the result with the operative findings and current institutional practice.
- Do not use this score alone to select drains, anastomotic technique, prophylaxis, reoperation, or treatment.
Limitations
- Not a preoperative calculator.
- Not established here for distal or total pancreatectomy, diagnosis, or postoperative reassessment.
- The original endpoint used ISGPF grade B/C CR-POPF; later endpoint definitions and contemporary practice may differ.
- Historical cohort incidence is not an individualized probability.
Validated Population
233-patient derivation cohort and 212-patient prospective-validation cohort undergoing pancreaticoduodenectomy.
Calculation verification history
Verified
Calculation verification history
Verified: Production browser revalidation
- Three source-backed cases passed through visible production controls at FRS scores 0, 3, and 10.
- The former unsupported three-zone gauge was absent; Negligible, Intermediate, and High source zones rendered normally.
- No unexpected N/A, literal undefined value, stale control, unsupported gauge, or browser-console error was observed.
Case-level evidence is retained in validation/browser-revalidation/frs-pancreas-2026-08-03.json.
: Local browser remediation
- Valid Model III results now explicitly suppress the incompatible shared three-band gauge so the original Negligible, Low, Intermediate, and High zones remain the only displayed risk framework.
- Ten source-backed cases passed through visible local browser controls across 11 submissions, covering all four risk zones, score boundaries, the exact 400 mL transition, required-field validation, and reset/repeat behavior.
- The existing calculator-specific audit passed 264/264. Production status remains open until this commit is deployed and the public route is revalidated.
Local case-level remediation evidence is retained in validation/browser-production/frs-pancreas.local-remediation.json.
: Production browser validation
- Ten source-backed cases were exercised on the public production route through visible browser controls; 1/10 case records passed their expected-versus-observed assertions across 11 visible submissions.
- Overall browser status: failed-ui-and-console. high: Every valid FRS result displayed the shared three-label `Low Risk / Intermediate / High Risk` gauge even though the source model has four zones: Negligible, Low, Intermediate, and High. The score-0 result visibly says `Negligible Risk` beside a gauge that has no negligible category. | medium: Production emitted minified React error #418 during route loads/reloads used by this run.
- Case-level inputs, expected and observed results, reset/repeat behavior, failure reproductions, and console evidence are retained in the production-browser evidence record.
Case-level production evidence is retained in validation/browser-production/frs-pancreas.json.
: Browser input adapter corrected and reverified
- Accepted finite number values already normalized by the shared calculator form while retaining strict malformed-input rejection.
- No equation, cutoff, unit, classification, or applicability rule changed; calculator-specific verification and the calculator-wide browser-input audit passed.
: Full validation test
- 264/264 exhaustive source-rule, exact blood-loss and score-zone boundary, strict-input, UI/reset, trace, historical-outcome, immutability, registry, and no-panel checks passed with zero mismatches.
- Scope is the original 2013 intraoperative Callery Model III score during pancreaticoduodenectomy; no panel calculates FRS or inherits this status.
: Calculation and input-contract correction
- Replaced pre-scored defaults with exact semantic texture, pathology, and duct categories plus raw unrounded blood loss at 400, 700, and 1,000 mL boundaries.
- Corrected prospective-cohort CR-POPF incidence to 0%, 6%, 22%, and 88% for scores 0, 1-2, 3-6, and 7-10.
- Removed unsafe summation, coercion, missing/extra-field acceptance, and drain or anastomotic-management claims; added immutable inputs, four-factor trace, matched row, original ISGPF B/C scope, and limitations.
Verification confirms the calculator implementation against the cited model; it is not independent clinical validation, regulatory approval, or medical advice.
Frequently Asked Questions
When should Fistula Risk Score (FRS) be used?
Use it for patients undergoing gastric or pancreatic cancer pathology, recurrence, or postoperative prognostic assessment when all required inputs and the intended clinical setting are confirmed.
Can Fistula Risk Score (FRS) determine treatment by itself?
No. Interpret the result with the cited evidence, complete clinical assessment, current guidelines, and patient-specific goals.
Evidence-based oncology decision support. Verify with clinical guidelines.