A simple preoperative stratification tool predicting the risk of postoperative pancreatic fistula after pancreatoduodenectomy期刊界 All Journals 搜尽天下杂志传播学术成果专业期刊搜索期刊信息化学术搜索

A simple preoperative stratification tool predicting the risk of postoperative pancreatic fistula after pancreatoduodenectomy

Affiliation:	1. Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23562 Luebeck, Germany;2. Department of Neuroradiology, University Medical Center Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23562 Luebeck, Germany;3. Department of Radiology, University Medical Center Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23562 Luebeck, Germany;4. Department of General Surgery, Bogomolets National Medical Unoversity, Kiev, Ukraine;1. Department of Gastroenterology and Hepatology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic;2. Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA;3. Department of Gastroenterology, Hepatology and Nutrition, University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA;4. Clinic of Internal Medicine, University Hospital Ostrava, Ostrava, Czech Republic;5. Gastroenterology Unit, Pancreas Center, University of Verona, Verona, Italy;6. Third Department of Internal Medicine, Kansai Medical University, Osaka, Japan;7. Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan;8. Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan;9. Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan;10. Department of Gastroenterology, San Carlo Hospital, Potenza, Italy;11. Department of Medicine Huddinge, Karolinska Institute, Stockholm, Sweden;12. Department for Upper Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden;13. CLINTEC, Karolinska Institute, Stockholm, Sweden;14. Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden;1. Department of Pathology, Jeju National University Hospital, Jeju-si, South Korea;2. Department of Pathology and Molecular Diagnostic Laboratory, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea;1. Division of Gastroenterology and Hepatology, Rutgers Robert Wood Johnson School of Medicine, New Brunswick, NJ, United States;2. Division of Gastroenterology and Hepatology, John H. Stroger Cook County Hospital, Chicago, IL, United States;3. Department of Gastroenterology, BIDMC, Boston, United States;4. Division of Pulmonary and Critical Care, Mayo Clinic, Rochester, United States;5. Division of Gastroenterology and Hepatology, Fox Chase Cancer Center, Philadelphia, United States;6. Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, United States;1. Department of Gastrointestinal Surgery, Haydarpasa Numune Training and Research Hospital, University of Health Sciences, Istanbul, Turkey;2. Department of General Surgery, Haydarpasa Numune Training and Research Hospital, University of Health Sciences, Istanbul, Turkey;3. Department of Medical Biochemistry, Haydarpasa Numune Training and Research Hospital, University of Health Sciences, Istanbul, Turkey;1. Department of Surgery, Kansai Medical University, 2-5-1 Shin-machi, Hirakata-city, Osaka, 573-1010, Japan;2. Department of Pathology and Clinical Laboratory, Kansai Medical University, 2-5-1 Shin-machi, Hirakata-city, Osaka, 573-1010, Japan;3. Department of Surgery, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan;1. Department of Surgery, University Medical Center Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23562, Luebeck, Germany;2. Department of Neuroradiology, University Medical Center Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23562, Luebeck, Germany;3. Department of Radiology, University Medical Center Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23562, Luebeck, Germany;4. Department of General Surgery, Bogomolets National Medical University, Bogomolets, 01601, Kiev, No 13, Shevchenko Av, Ukraine;5. Department of Surgery, Marien Hospital Herne, University Hospital of Ruhr University Bochum, Hölkeskampring 40, 44625, Herne, Germany

Abstract:	BackgroundPostoperative pancreatic fistula (POPF) after pancreatoduodenectomy (PD) can be associated with severe postoperative morbidity. This study aims to develop a preoperative POPF risk calculator that can be easily implemented in clinical routine.MethodsPatients undergoing PD were identified from a prospectively-maintained database. A total of 11 preoperative baseline and CT-based radiological parameters were used in a binominal logistic regression model. Parameters remaining predictive for grade B/C POPF were entered into the risk calculator and diagnostic accuracy measures and ROC curves were calculated for a training and a test patient cohort. The risk calculator was transformed into a simple nomogram.ResultsA total of 242 patients undergoing PD in the period from 2012 to 2018 were included. CT-imaging-based maximum main pancreatic duct (MPD) diameter (p = 0.047), CT-imaging-based pancreatic gland diameter at the anticipated resection margin (p = 0.002) and gender (p = 0.058) were the parameters most predictive for grade B/C POPF. Based on these parameters, a risk calculator was developed to identify patients at high risk of developing grade B/C POPF. In a training cohort of PD patients this risk calculator was associated with an AUC of 0.808 (95%CI 0.726–0.874) and an AUC of 0.756 (95%CI 0.669-0-830) in the independent test cohort. A nomogram applicable as a visual risk scale for quick assessment of POPF grade B/C risk was developed.ConclusionThe preoperative POPF risk calculator provides a simple tool to stratify patients planned for PD according to the risk of developing postoperative grade B/C POPF. The nomogram visual risk scale can be easily integrated into clinical routine and may be a valuable model to select patients for POPF-preventive therapy or as a stratification tool for clinical trials.

Keywords:	Pancreatoduodenectomy Postoperative pancreatic fistula Preoperative risk calculation
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