Alhulaili Zahraa M, Pleijhuis Rick G, Nijkamp Maarten W, Klaase Joost M
Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands.
Department of Internal Medicine, University Medical Center Groningen, University of Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands.
Cancers (Basel). 2022 Nov 11;14(22):5551. doi: 10.3390/cancers14225551.
Pancreatoduodenectomy (PD) is the only cure for periampullary and pancreatic cancer. It has morbidity rates of 40-60%, with severe complications in 30%. Prediction models to predict complications are crucial. A risk model for severe complications was developed by Schroder et al. based on BMI, ASA classification and Hounsfield Units of the pancreatic body on the preoperative CT scan. These variables were independent predictors for severe complications upon internal validation. Our aim was to externally validate this model using an independent cohort of patients.
A retrospective analysis was performed on 318 patients who underwent PD at our institution from 2013 to 2021. The outcome of interest was severe complications Clavien-Dindo ≥ IIIa. Model calibration, discrimination and performance were assessed.
A total of 308 patients were included. Patients with incomplete data were excluded. A total of 89 (28.9%) patients had severe complications. The externally validated model achieved: C-index = 0.67 (95% CI: 0.60-0.73), regression coefficient = 0.37, intercept = 0.13, Brier score = 0.25.
The performance ability, discriminative power, and calibration of this model were acceptable. Our risk calculator can help surgeons identify high-risk patients for post-operative complications to improve shared decision-making and tailor perioperative management.
胰十二指肠切除术（PD）是壶腹周围癌和胰腺癌的唯一治愈方法。其发病率为40%-60%，其中30%会出现严重并发症。预测并发症的模型至关重要。施罗德等人基于体重指数（BMI）、美国麻醉医师协会（ASA）分级以及术前CT扫描中胰体的亨氏单位，开发了一种严重并发症风险模型。这些变量在内部验证中是严重并发症的独立预测因素。我们的目的是使用一个独立的患者队列对该模型进行外部验证。
对2013年至2021年在我院接受PD手术的318例患者进行回顾性分析。感兴趣的结局是Clavien-Dindo≥IIIa级严重并发症。评估模型的校准、区分度和性能。
共纳入308例患者。排除数据不完整的患者。共有89例（28.9%）患者出现严重并发症。外部验证后的模型结果为：C指数=0.67（95%置信区间：0.60-0.73），回归系数=0.37，截距=0.13，Brier评分=0.25。
该模型的性能、区分能力和校准情况均可接受。我们的风险计算器可帮助外科医生识别术后并发症的高危患者，以改善共同决策并制定个体化的围手术期管理方案。
