AlMasri Samer, Kim Victoria M, Hodges Jacob C, Casciani Fabio, Lee Kenneth K, Paniccia Alessandro, Vollmer Charles M, Zureikat Amer H
Department of Surgery, University of Pittsburgh Medical Center, Mechanicsburg, PA.
Wolff Center at University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
Ann Surg. 2024 Aug 26. doi: 10.1097/SLA.0000000000006513.
To evaluate whether drain fluid amylase levels on day-1 (DFA1) and day-3 (DFA3) can reliably estimate the risk of clinically relevant-postoperative pancreatic fistula (CR-POPF) following pancreatoduodenectomy (PD) compared to either value alone or in combination with clinicopathologic variables.
CR-POPF is a major source of morbidity and mortality following PD. Current drain management algorithms are variable and are mostly dependent on DFA1, while the DFA3 is seldom utilized to guide clinical decision making.
Between 2015-2020, patients who underwent PD at two high-volume pancreas centers and had intraoperative drain placement with measurement of DFA1 and DFA3 were retrospectively reviewed. Models to predict CR-POPF were constructed using DFA1, DFA3, fistula risk score (FRS) and other patient or treatment-related parameters. The fittest and more parsimonious model was used to construct a CR-POPF risk calculator.
Nine-hundred-twenty-three patients were included in the analysis. The FRS was high in 100(10.9%), intermediate in 524(57.3%), low in 211(23.1%) and negligible in 79(8.6%) patients. The overall rate of CR-POPF was 9.2%. Five logistic regression models were constructed using variables known to be implicated in CR-POPF. A model based solely on DFA1 and DFA3 with a cross-validated area under the curve of 0.846 was selected. A calculator using DFA1 and DFA3 was created based on this model to estimate the risk of CR-POPF.
Risk of CR-POPF following pancreatoduodenectomy can be accurately estimated based on measurement of DFA1 and DFA3. Our CR-POPF kinetics calculator can facilitate postoperative risk stratification and guide drain management algorithms.
评估与单独使用第1天（DFA1）或第3天（DFA3）的引流液淀粉酶水平，或与临床病理变量联合使用相比，DFA1和DFA3能否可靠地估计胰十二指肠切除术（PD）后临床相关术后胰瘘（CR-POPF）的风险。
CR-POPF是PD后发病和死亡的主要原因。目前的引流管理算法各不相同，大多依赖DFA1，而DFA3很少用于指导临床决策。
回顾性分析2015年至2020年间在两个高容量胰腺中心接受PD且术中放置引流管并测量DFA1和DFA3的患者。使用DFA1、DFA3、瘘管风险评分（FRS）以及其他患者或治疗相关参数构建预测CR-POPF的模型。采用最适合且更简约的模型构建CR-POPF风险计算器。
923例患者纳入分析。100例（10.9%）患者FRS高，524例（57.3%）患者FRS中等，211例（23.1%）患者FRS低，79例（8.6%）患者FRS可忽略不计。CR-POPF的总体发生率为9.2%。使用已知与CR-POPF相关的变量构建了五个逻辑回归模型。选择了一个仅基于DFA1和DFA3的模型，其交叉验证曲线下面积为0.846。基于该模型创建了一个使用DFA1和DFA3的计算器来估计CR-POPF的风险。
基于DFA1和DFA3的测量可以准确估计胰十二指肠切除术后CR-POPF的风险。我们的CR-POPF动力学计算器有助于术后风险分层并指导引流管理算法。
