A simple preoperative stratification tool predicting the risk of postoperative pancreatic fistula after pancreatoduodenectomy
Publikation: Beitrag in Fachzeitschrift › Forschungsartikel › Beigetragen › Begutachtung
Beitragende
Abstract
BACKGROUND: Postoperative pancreatic fistula (POPF) after pancreatoduodenectomy (PD) can be associated with severe postoperative morbidity. This study aims to develop a preoperative POPF risk calculator that can be easily implemented in clinical routine.
METHODS: Patients undergoing PD were identified from a prospectively-maintained database. A total of 11 preoperative baseline and CT-based radiological parameters were used in a binominal logistic regression model. Parameters remaining predictive for grade B/C POPF were entered into the risk calculator and diagnostic accuracy measures and ROC curves were calculated for a training and a test patient cohort. The risk calculator was transformed into a simple nomogram.
RESULTS: A total of 242 patients undergoing PD in the period from 2012 to 2018 were included. CT-imaging-based maximum main pancreatic duct (MPD) diameter (p = 0.047), CT-imaging-based pancreatic gland diameter at the anticipated resection margin (p = 0.002) and gender (p = 0.058) were the parameters most predictive for grade B/C POPF. Based on these parameters, a risk calculator was developed to identify patients at high risk of developing grade B/C POPF. In a training cohort of PD patients this risk calculator was associated with an AUC of 0.808 (95%CI 0.726-0.874) and an AUC of 0.756 (95%CI 0.669-0-830) in the independent test cohort. A nomogram applicable as a visual risk scale for quick assessment of POPF grade B/C risk was developed.
CONCLUSION: The preoperative POPF risk calculator provides a simple tool to stratify patients planned for PD according to the risk of developing postoperative grade B/C POPF. The nomogram visual risk scale can be easily integrated into clinical routine and may be a valuable model to select patients for POPF-preventive therapy or as a stratification tool for clinical trials.
Details
Originalsprache | Englisch |
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Seiten (von - bis) | 957-964 |
Seitenumfang | 8 |
Fachzeitschrift | Pancreatology |
Jahrgang | 21 |
Ausgabenummer | 5 |
Publikationsstatus | Veröffentlicht - Aug. 2021 |
Peer-Review-Status | Ja |
Extern publiziert | Ja |
Externe IDs
Scopus | 85103281356 |
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Schlagworte
Schlagwörter
- Humans, Pancreas/surgery, Pancreatic Ducts/surgery, Pancreatic Fistula/epidemiology, Pancreaticoduodenectomy/adverse effects, Postoperative Complications/epidemiology, Retrospective Studies, Risk Assessment, Risk Factors