Division of General and Transplant Surgery, University of Pisa, Italy.
Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy; Department of Surgery, Amsterdam UMC, University of Amsterdam, Netherlands; Cancer Center Amsterdam, Netherlands.
Surgery. 2023 Jun;173(6):1438-1446. doi: 10.1016/j.surg.2023.02.020. Epub 2023 Mar 25.
Difficulty scoring systems are important for the safe, stepwise implementation of new procedures. We designed a retrospective observational study for building a difficulty score for robotic pancreatoduodenectomy.
The difficulty score (PD-ROBOSCORE) aims at predicting severe postoperative complications after robotic pancreatoduodenectomy. The PD-ROBOSCORE was developed in a training cohort of 198 robotic pancreatoduodenectomies and was validated in an international multicenter cohort of 686 robotic pancreatoduodenectomies. Finally, all centers tested the model during the early learning curve (n = 300). Growing difficulty levels (low, intermediate, high) were defined using cut-off values set at the 33rd and 66th percentile (NCT04662346).
Factors included in the final multivariate model were a body mass index of ≥25 kg/m for males and ≥30 kg/m for females (odds ratio:2.39; P < .0001), borderline resectable tumor (odd ratio:1.98; P < .0001), uncinate process tumor (odds ratio:1.69; P < .0001), pancreatic duct size <4 mm (odds ratio:1.59; P < .0001), American Society of Anesthesiologists class ≥3 (odds ratio:1.59; P < .0001), and hepatic artery originating from the superior mesenteric artery (odds ratio:1.43; P < .0001). In the training cohort, the absolute score value (odds ratio = 1.13; P = .0089) and difficulty groups (odds ratio = 2.35; P = .041) predicted severe postoperative complications. In the multicenter validation cohort, the absolute score value predicted severe postoperative complications (odds ratio = 1.16, P < .001), whereas the difficulty groups did not (odds ratio = 1.94, P = .082). In the learning curve cohort, both absolute score value (odds ratio:1.078, P = .04) and difficulty groups (odds ratio: 2.25, P = .017) predicted severe postoperative complications. Across all cohorts, a PD-ROBOSCORE of ≥12.51 doubled the risk of severe postoperative complications. The PD-ROBOSCORE score also predicted operative time, estimated blood loss, and vein resection. The PD-ROBOSCORE predicted postoperative pancreatic fistula, delayed gastric emptying, postpancreatectomy hemorrhage, and postoperative mortality in the learning curve cohort.
The PD-ROBOSCORE predicts severe postoperative complications after robotic pancreatoduodenectomy. The score is readily available via www.pancreascalculator.com.
难度评分系统对于新手术的安全、逐步实施非常重要。我们设计了一项回顾性观察研究，旨在为机器人胰十二指肠切除术建立一个难度评分系统。
该难度评分系统（PD-ROBOSCORE）旨在预测机器人胰十二指肠切除术后严重的术后并发症。PD-ROBOSCORE 是在 198 例机器人胰十二指肠切除术的训练队列中开发的，并在国际多中心的 686 例机器人胰十二指肠切除术的验证队列中进行了验证。最后，所有中心在早期学习曲线期间对该模型进行了测试（n=300）。通过设定第 33 百分位和第 66 百分位的截断值（NCT04662346）来定义递增的难度级别（低、中、高）。
最终多变量模型中纳入的因素包括男性体质量指数≥25kg/m2，女性体质量指数≥30kg/m2（比值比：2.39；P＜0.0001）、边界可切除肿瘤（比值比：1.98；P＜0.0001）、钩突肿瘤（比值比：1.69；P＜0.0001）、胰管直径＜4mm（比值比：1.59；P＜0.0001）、美国麻醉医师协会分级≥3 级（比值比：1.59；P＜0.0001）和肝总动脉发自肠系膜上动脉（比值比：1.43；P＜0.0001）。在训练队列中，绝对评分值（比值比=1.13；P=0.0089）和难度组（比值比=2.35；P=0.041）预测严重的术后并发症。在多中心验证队列中，绝对评分值预测严重的术后并发症（比值比=1.16，P＜0.001），而难度组则没有（比值比=1.94，P=0.082）。在学习曲线队列中，绝对评分值（比值比：1.078，P=0.04）和难度组（比值比：2.25，P=0.017）均预测严重的术后并发症。在所有队列中，PD-ROBOSCORE 评分≥12.51 使严重术后并发症的风险增加一倍。PD-ROBOSCORE 评分还可预测手术时间、估计失血量和静脉切除情况。PD-ROBOSCORE 在学习曲线队列中预测术后胰瘘、胃排空延迟、胰十二指肠切除术后出血和术后死亡率。
PD-ROBOSCORE 可预测机器人胰十二指肠切除术后严重的术后并发症。该评分系统可通过 www.pancreascalculator.com 获得。
