Nicolas Tabchouri1,2, Morgane Bouquot3, Hélène Hermand1, Olivier Benoit1, Jean-Christophe Loiseau4, Safi Dokmak1, Béatrice Aussilhou1, Sébastien Gaujoux1, Olivier Turrini3, Jean Robert Delpero3, Alain Sauvanet5,6,7. 1. Department of HPB Surgery, Hôpital Beaujon, Paris, France. 2. Department of Digestive Surgery, Hôpital Trousseau, Tours, France. 3. Department of Digestive Surgery, Institut Paoli Calmettes, Marseille, France. 4. DynFluid Laboratory, Arts et Métiers Paris Tech, Paris, France. 5. Department of HPB Surgery, Hôpital Beaujon, Paris, France. alain.sauvanet@aphp.fr. 6. University Paris, Paris, France. alain.sauvanet@aphp.fr. 7. AP-HP, Department of HBP Surgery, DIGEST Medico-Universitary Department, Hôpital Beaujon APHP, 100 boulevard du Général Leclerc, 92110, Clichy, France. alain.sauvanet@aphp.fr.
Abstract
BACKGROUND: Postoperative pancreatic fistula (POPF) is the most serious complication following pancreaticoduodenectomy (PD). Identifying patients at high or low risk of developing POPF is important in perioperative management. This study aimed to determine a predictive risk score for POPF following PD, and compare it to preexisting scores. METHODS: All patients who underwent open PD from 2012 to 2017 in two high-volume centers were included. The training dataset was used for the development of the POPF predictive risk score (using the 2016 ISGPS definition), while the testing dataset was used for external validation. The proposed score was compared to the fistula risk score (FRS), the NSQIP-modified FRS (mFRS), and the alternative FRS (aFRS). RESULTS: Overall, 448 and 213 patients were included in the training and testing datasets, respectively. A probabilistic predictive risk score was developed using four independent POPF risk factors (increasing age, no preoperative radiation therapy, soft pancreatic stump, and decreasing main pancreatic duct diameter). The discriminative capacities of the new score, FRS, mFRS, and aFRS were similar (AUC ranging from 0.73 to 0.79 in the training cohort and from 0.73 to 0.76 in the testing cohort). However, the new score identified more specifically patients at low risk of POPF compared with other scores, in both cohorts, with a 6% false-negative rate. CONCLUSIONS: Preoperative radiation therapy is an independent protective factor of POPF following PD. It should be included in the risk score of POPF to identify more precisely patients at low risk for this complication.
BACKGROUND:Postoperative pancreatic fistula (POPF) is the most serious complication following pancreaticoduodenectomy (PD). Identifying patients at high or low risk of developing POPF is important in perioperative management. This study aimed to determine a predictive risk score for POPF following PD, and compare it to preexisting scores. METHODS: All patients who underwent open PD from 2012 to 2017 in two high-volume centers were included. The training dataset was used for the development of the POPF predictive risk score (using the 2016 ISGPS definition), while the testing dataset was used for external validation. The proposed score was compared to the fistula risk score (FRS), the NSQIP-modified FRS (mFRS), and the alternative FRS (aFRS). RESULTS: Overall, 448 and 213 patients were included in the training and testing datasets, respectively. A probabilistic predictive risk score was developed using four independent POPF risk factors (increasing age, no preoperative radiation therapy, soft pancreatic stump, and decreasing main pancreatic duct diameter). The discriminative capacities of the new score, FRS, mFRS, and aFRS were similar (AUC ranging from 0.73 to 0.79 in the training cohort and from 0.73 to 0.76 in the testing cohort). However, the new score identified more specifically patients at low risk of POPF compared with other scores, in both cohorts, with a 6% false-negative rate. CONCLUSIONS: Preoperative radiation therapy is an independent protective factor of POPF following PD. It should be included in the risk score of POPF to identify more precisely patients at low risk for this complication.
Authors: Kevin A Chen; Matthew E Berginski; Chirag S Desai; Jose G Guillem; Jonathan Stem; Shawn M Gomez; Muneera R Kapadia Journal: J Gastrointest Surg Date: 2022-05-04 Impact factor: 3.267
Authors: Christopher Ryan Deig; Thomas Lee Sutton; Blake Beneville; Kristin Trone; Amanda Stratton; Ali N Gunesch; Amy Ivy Liu; Alaaeddin Alrohaibani; Maedeh Mohebnasab; Solange Bassale; Alison Grossblatt-Wait; Dove Keith; Fouad Attia; Erin W Gilbert; Charles D Lopez; Adel Kardosh; Emerson Y Chen; Kenneth G Bensch; Nima Nabavizadeh; Charles R Thomas; Skye C Mayo; Brett C Sheppard; Aaron Grossberg Journal: Cancers (Basel) Date: 2022-01-26 Impact factor: 6.639