Department of Hepatopancreatobiliary Surgery, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou, China.
Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.
Surg Endosc. 2024 May;38(5):2622-2631. doi: 10.1007/s00464-024-10770-6. Epub 2024 Mar 18.
Postoperative pancreatic fistula (POPF) is the most prevalent complications following minimally invasive pancreaticoduodenectomy (MIPD). Only one model related to MIPD exists, and previous POPF scoring prediction methods are based on open pancreaticoduodenectomy patients. Our objectives are to determine the variables that may increase the probability of pancreatic fistula following MIPD and to develop and validate a POPF predictive risk model.
Data from 432 patients who underwent MIPD between July 2015 and May 2022 were retrospectively collected. A nomogram prediction model was created using multivariate logistic regression analysis to evaluate independent factors for POPF in patients undergoing MIPD in the modeling cohort. The area under the curve (AUC) of the receiver operating characteristic curve (ROC) and the calibration curve were used to verify the nomogram prediction model internally and externally within the modeling cohort and the verification cohort.
Multivariate logistic regression analysis showed that body mass index (BMI), albumin, triglycerides, pancreatic duct diameter, pathological diagnosis and intraoperative bleeding were independent variables for POPF. On the basis of this information, a model for the prediction of risks associated with POPF was developed. In accordance with the ROC analysis, the modeling cohort's AUC was 0.819 (95% CI 0.747-0.891), the internal validation cohort's AUC was 0.830 (95% CI 0.747-0.912), and the external validation cohort's AUC was 0.793 (95% CI 0.671-0.915). Based on the calibration curve, the estimated values of POPF have a high degree of concordance with the actual values that were measured.
This model for predicting the probability of pancreatic fistula following MIPD has strong predictive capacity and can provide a trustworthy predictive method for the early screening of high-risk patients with pancreatic fistula after MIPD and timely clinical intervention.
微创胰十二指肠切除术（MIPD）后胰瘘（POPF）是最常见的并发症。目前仅有一个与 MIPD 相关的模型，且之前的 POPF 评分预测方法都是基于接受开腹胰十二指肠切除术的患者。我们的目标是确定可能增加 MIPD 后发生胰瘘概率的变量，并开发和验证 POPF 预测风险模型。
回顾性收集了 2015 年 7 月至 2022 年 5 月期间接受 MIPD 的 432 名患者的数据。使用多变量逻辑回归分析创建了一个列线图预测模型，以评估建模队列中接受 MIPD 的患者发生 POPF 的独立因素。使用接受者操作特征曲线（ROC）的曲线下面积（AUC）和校准曲线对内和外部验证队列中的列线图预测模型进行验证。
多变量逻辑回归分析显示，体重指数（BMI）、白蛋白、甘油三酯、胰管直径、病理诊断和术中出血是 POPF 的独立变量。在此基础上，建立了预测 POPF 风险的模型。根据 ROC 分析，建模队列的 AUC 为 0.819（95%CI 0.747-0.891），内部验证队列的 AUC 为 0.830（95%CI 0.747-0.912），外部验证队列的 AUC 为 0.793（95%CI 0.671-0.915）。根据校准曲线，POPF 的估计值与实测值具有高度一致性。
该模型对 MIPD 后胰瘘的发生概率具有较强的预测能力，可为 MIPD 后高危胰瘘患者的早期筛查和及时的临床干预提供可靠的预测方法。
