A simple preoperative stratification tool predicting the risk of postoperative pancreatic fistula after pancreatoduodenectomy

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • Hryhoriy Lapshyn - , Universitätsklinikum Schleswig-Holstein - Campus Lübeck (Author)
  • Natalie Petruch - , Universitätsklinikum Schleswig-Holstein - Campus Lübeck (Author)
  • Michael Thomaschewski - , Universitätsklinikum Schleswig-Holstein - Campus Lübeck (Author)
  • Stefan Sondermann - , Universitätsklinikum Schleswig-Holstein - Campus Lübeck (Author)
  • Katharina May - , Universitätsklinikum Schleswig-Holstein - Campus Lübeck (Author)
  • Laura Frohneberg - , Universitätsklinikum Schleswig-Holstein - Campus Lübeck (Author)
  • Ekaterina Petrova - , Universitätsklinikum Schleswig-Holstein - Campus Lübeck (Author)
  • Sergii Zemskov - , Klinikum Chemnitz gGmbH (Author)
  • Kim C Honselmann - , Universitätsklinikum Schleswig-Holstein - Campus Lübeck (Author)
  • Rüdiger Braun - , Universitätsklinikum Schleswig-Holstein - Campus Lübeck (Author)
  • Tobias Keck - , Universitätsklinikum Schleswig-Holstein - Campus Lübeck (Author)
  • Ulrich F Wellner - , Universitätsklinikum Schleswig-Holstein - Campus Lübeck (Author)
  • Louisa Bolm - , Universitätsklinikum Schleswig-Holstein - Campus Lübeck (Author)

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

Original languageEnglish
Pages (from-to)957-964
Number of pages8
JournalPancreatology
Volume21
Issue number5
Publication statusPublished - Aug 2021
Peer-reviewedYes
Externally publishedYes

External IDs

Scopus 85103281356

Keywords

Keywords

  • Humans, Pancreas/surgery, Pancreatic Ducts/surgery, Pancreatic Fistula/epidemiology, Pancreaticoduodenectomy/adverse effects, Postoperative Complications/epidemiology, Retrospective Studies, Risk Assessment, Risk Factors