Department of Gastroenterological Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Departments of Gastroenterological Surgery and Transplantation and Liver Surgery Helsinki University Hospital and University of HelsinkiHaartmaninkatu 400029 Helsinki Finland.
Scand J Surg. 2023 Jun;112(2):126-134. doi: 10.1177/14574969231167781. Epub 2023 Apr 21.
Postoperative pancreatic fistula (POPF) is the leading cause of morbidity and early mortality in patients undergoing pancreatic resection. In addition, recent studies have identified postoperative acute pancreatitis (POAP) as an independent contributor to morbidity. Most perioperative mitigation strategies experimented for POPF have been shown to be in vain with no consensus on the best perioperative management. Clinical prediction models have been developed with the hope of identifying high POPF risk patients with the leading idea of finding subpopulations possibly benefiting from pre-existing or novel mitigation strategies. The aim of this review was to map out the existing prediction modeling studies to better understand the current stage of POPF prediction modeling, and the methodology behind them.
A narrative review of the existing POPF prediction model studies was performed. Studies published before September 2022 were included.
While the number of POPF prediction models for pancreatoduodenectomy has increased, none of the currently existing models stand out from the crowd. For distal pancreatectomy, two unique POPF prediction models exist, but due to their freshness, no further external validation or adoption in clinics or research has been reported. There seems to be a lack of adherence to correct methodology or reporting guidelines in most of the studies, which has rendered external validity-if assessed-low. Few of the most recent studies have demonstrated preoperative assessment of pancreatic aspects from computed tomography (CT) scans to provide relatively strong predictors of POPF.
Main goal for the future would be to reach a consensus on the most important POPF predictors and prediction model. At their current state, few models have demonstrated adequate transportability and generalizability to be up to the task. Better understanding of POPF pathophysiology and the possible driving force of acute inflammation and POAP might be required before such a prediction model can be accessed.
术后胰腺瘘（POPF）是胰腺切除术后患者发病率和早期死亡率的主要原因。此外，最近的研究表明术后急性胰腺炎（POAP）是发病率的一个独立因素。大多数针对 POPF 的围手术期缓解策略都已被证明无效，对于最佳围手术期管理也没有共识。临床预测模型的开发是为了希望能够识别出高 POPF 风险患者，其主要理念是找到可能受益于现有或新的缓解策略的亚人群。本综述的目的是绘制现有的预测模型研究图，以更好地了解当前 POPF 预测模型的阶段以及它们背后的方法。
对现有的 POPF 预测模型研究进行了叙述性综述。纳入了 2022 年 9 月之前发表的研究。
虽然胰十二指肠切除术的 POPF 预测模型数量有所增加，但目前没有一个模型能够脱颖而出。对于胰体尾切除术，有两个独特的 POPF 预测模型，但由于它们还很新颖，尚未有进一步的外部验证或在临床或研究中采用的报道。大多数研究似乎缺乏对正确方法或报告指南的遵循，这使得外部有效性（如果进行评估）较低。最近的一些研究已经证明了术前从计算机断层扫描（CT）扫描评估胰腺方面可以提供相对较强的 POPF 预测指标。
未来的主要目标是就最重要的 POPF 预测因子和预测模型达成共识。就目前的情况而言，很少有模型能够表现出足够的可转移性和通用性来胜任这项任务。在能够访问这样的预测模型之前，可能需要更好地了解 POPF 的病理生理学以及急性炎症和 POAP 的可能驱动力。
