Nassour Ibrahim, AlMasri Samer, Hodges Jacob C, Hughes Steven J, Zureikat Amer, Paniccia Alessandro
Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA.
Department of Surgery, Division of GI Surgical Oncology, University of Pittsburgh Medical Center, 497 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA, 15261, USA.
J Gastrointest Surg. 2022 Jul;26(7):1436-1444. doi: 10.1007/s11605-022-05275-3. Epub 2022 Mar 29.
Drain management algorithms are based on studies that predict clinically relevant postoperative pancreatic fistula (CR-POPF) using drain fluid amylase level on POD1 (DFA1). These studies are focused on pancreaticoduodenectomy which is inherently different than distal pancreatectomy. Moreover, the change of DFA between POD1 and POD3 (ΔDFA) is underutilized despite its importance in predicting CR-POPF. We sought to generate a calculator that estimates the risk of CR-POPF following distal pancreatectomy.
The 2014-2018 pancreas-targeted ACS-NSQIP database was used to identify patients who underwent elective distal pancreatectomy. Models to predict CR-POPF were constructed using DFA1 with/without ΔDFA. The fittest model was used to construct a calculator.
Out of 12,042 distal pancreatectomies, 692 patients met the study's inclusion criteria. The risk of CR-POPF was 15.9% in the included cohort versus 14.8% in the excluded one (P = 0.421). The predictors of the CR-POPF were age, operative time, DFA1, and ΔDFA. Adding ΔDFA decreased the Akaike's information criterion of the model (507.7 vs 544.7)-indicating a significantly better model fit-and improved the cross-validated area under the curve from 0.731 to 0.791. An easy-to-use calculator was created for surgeons to estimate the risk of CR-POPF based on the abovementioned variables. A sensitivity/specificity table was created at various cutoffs to direct clinical decision-making with respect to early drain removal.
This study highlights the importance of ΔDFA, in addition to DFA1, in predicting CR-POPF. The provided calculator will facilitate predicting CR-POPF and postoperative drain management following distal pancreatectomy.
引流管理算法基于一些研究，这些研究利用术后第1天引流液淀粉酶水平（DFA1）来预测临床相关的术后胰瘘（CR-POPF）。这些研究主要集中在胰十二指肠切除术，而该手术与远端胰腺切除术本质上不同。此外，尽管术后第1天和第3天的DFA变化（ΔDFA）在预测CR-POPF方面很重要，但尚未得到充分利用。我们试图生成一个计算器，以估计远端胰腺切除术后CR-POPF的风险。
使用2014 - 2018年胰腺靶向的美国外科医师学会国家外科质量改进计划（ACS-NSQIP）数据库，识别接受择期远端胰腺切除术的患者。使用DFA1（有/无ΔDFA）构建预测CR-POPF的模型。采用最适合的模型构建计算器。
在12,042例远端胰腺切除术中，692例患者符合研究纳入标准。纳入队列中CR-POPF的风险为15.9%，排除队列中为14.8%（P = 0.421）。CR-POPF的预测因素为年龄、手术时间、DFA1和ΔDFA。加入ΔDFA降低了模型的赤池信息准则（507.7对544.7），表明模型拟合显著改善，并将交叉验证曲线下面积从0.731提高到0.791。为外科医生创建了一个易于使用的计算器，用于根据上述变量估计CR-POPF的风险。创建了一个敏感性/特异性表，列出了不同临界值，以指导关于早期拔除引流管的临床决策。
本研究强调了除DFA1外，ΔDFA在预测CR-POPF中的重要性。提供的计算器将有助于预测远端胰腺切除术后的CR-POPF和术后引流管理。
