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Probability of postoperative pancreatic fistula (POPF): ...
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Probability of postoperative pancreatic fistula (POPF):
Outcome stratification
Conditional information
Result interpretation
BACKGROUND: MIPD may be associated with an increased risk of postoperative pancreatic fistula (POPF). The a-FRS could allow for risk-adjusted comparisons in research and improve preventive strategies for high-risk patients. The a-FRS, however, has not yet been validated specifically for laparoscopic, robot-assisted and hybrid MIPD.
METHODS: A validation study was performed in a pan-European cohort of 952 consecutive patients undergoing MIPD (543 laparoscopic, 258 robot-assisted, 151 hybrid) in 26 centers from 7 countries between 2007 and 2017. The primary outcome was POPF (ISGPS grade B/C). Model performance was assessed using the area under the receiver-operating-curve (AUC; discrimination) and calibration plots. Validation included univariable screening for clinical variables that could improve performance.
RESULTS: Overall, 202 of 952 patients (21%) developed POPF after MIPD. Before adjustment, the original a-FRS performed moderately (AUC 0.68) and calibration was inadequate with systematic underestimation of the POPF risk. Single-row pancreatojejunostomy (OR 4.6, 95-CI 2.8-7.6) and male sex (OR 1.8, 95-CI 1.4-2.7) were identified as important risk factors for POPF in MIPD. The updated a-FRS, consisting of BMI, pancreatic texture, duct size, and male sex, showed good discrimination (AUC 0.75, 95-CI 0.71-0.79) and adequate calibration. Performance was adequate for laparoscopic, robot-assisted, and hybrid MIPD as well as open pancreatoduodenectomy (OPD).
CONCLUSIONS: The updated a-FRS (www.pancreascalculator.com) now includes male sex as a risk factor and is validated for both MIPD and OPD. The increased risk of POPF in MIPD was related to single-row pancreatojejunostomy, which should therefore be discouraged.
REFERENCES: Mungroop TH, Klompmaker S, Wellner UF, et al. Updated alternative fistula risk score (ua-FRS) to include minimally invasive pancreatoduodenectomy: pan-European validation. Annals of Surgery (2019) - Article in press.
Calculations alone should never dictate patient care, and are no substitute for professional judgement. See our full disclaimer.
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