General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy.
Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands.
Ann Surg. 2023 May 1;277(5):e1099-e1105. doi: 10.1097/SLA.0000000000005497. Epub 2022 Jul 7.
To develop 2 distinct preoperative and intraoperative risk scores to predict postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP) to improve preventive and mitigation strategies, respectively.
POPF remains the most common complication after DP. Despite several known risk factors, an adequate risk model has not been developed yet.
Two prediction risk scores were designed using data of patients undergoing DP in 2 Italian centers (2014-2016) utilizing multivariable logistic regression. The preoperative score (calculated before surgery) aims to facilitate preventive strategies and the intraoperative score (calculated at the end of surgery) aims to facilitate mitigation strategies. Internal validation was achieved using bootstrapping. These data were pooled with data from 5 centers from the United States and the Netherlands (2007-2016) to assess discrimination and calibration in an internal-external validation procedure.
Overall, 1336 patients after DP were included, of whom 291 (22%) developed POPF. The preoperative distal fistula risk score (preoperative D-FRS) included 2 variables: pancreatic neck thickness [odds ratio: 1.14; 95% confidence interval (CI): 1.11-1.17 per mm increase] and pancreatic duct diameter (OR: 1.46; 95% CI: 1.32-1.65 per mm increase). The model performed well with an area under the receiver operating characteristic curve of 0.83 (95% CI: 0.78-0.88) and 0.73 (95% CI: 0.70-0.76) upon internal-external validation. Three risk groups were identified: low risk (<10%), intermediate risk (10%-25%), and high risk (>25%) for POPF with 238 (18%), 684 (51%), and 414 (31%) patients, respectively. The intraoperative risk score (intraoperative D-FRS) added body mass index, pancreatic texture, and operative time as variables with an area under the receiver operating characteristic curve of 0.80 (95% CI: 0.74-0.85).
The preoperative and the intraoperative D-FRS are the first validated risk scores for POPF after DP and are readily available at: http://www.pancreascalculator.com . The 3 distinct risk groups allow for personalized treatment and benchmarking.
开发 2 种独特的术前和术中风险评分，以预测胰尾部切除术（DP）后的术后胰瘘（POPF），分别用于改进预防和缓解策略。
POPF 仍然是 DP 后最常见的并发症。尽管有几个已知的风险因素，但尚未开发出足够的风险模型。
使用来自意大利 2 个中心（2014-2016 年）的接受 DP 的患者的数据，利用多变量逻辑回归设计了 2 种预测风险评分。术前评分（在手术前计算）旨在促进预防策略，而术中评分（在手术结束时计算）旨在促进缓解策略。内部验证采用自举法实现。将这些数据与来自美国和荷兰的 5 个中心的数据（2007-2016 年）合并，以在内部-外部验证过程中评估区分度和校准度。
共纳入 1336 例 DP 后患者，其中 291 例（22%）发生 POPF。术前远端瘘管风险评分（术前 D-FRS）包括 2 个变量：胰颈厚度[比值比：1.14；95%置信区间（CI）：每增加 1 毫米增加 1.11-1.17]和胰管直径（OR：1.46；95%CI：每增加 1 毫米增加 1.32-1.65）。该模型表现良好，内部-外部验证的受试者工作特征曲线下面积分别为 0.83（95%CI：0.78-0.88）和 0.73（95%CI：0.70-0.76）。确定了 3 个风险组：POPF 的低风险（<10%）、中风险（10%-25%）和高风险（>25%），分别有 238（18%）、684（51%）和 414（31%）例患者。术中风险评分（术中 D-FRS）增加了体重指数、胰腺质地和手术时间作为变量，受试者工作特征曲线下面积为 0.80（95%CI：0.74-0.85）。
术前和术中 D-FRS 是 DP 后 POPF 的首个验证风险评分，可在以下网址获得：http://www.pancreascalculator.com。3 个不同的风险组允许个性化治疗和基准测试。
