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. 2014 Jul;16(7):620-8.
doi: 10.1111/hpb.12186. Epub 2013 Nov 8.

A preoperative predictive score of pancreatic fistula following pancreatoduodenectomy

Keith J Roberts  1 , James Hodson, Homoyoon Mehrzad, Ravi Marudanayagam, Robert P Sutcliffe, Paolo Muiesan, John Isaac, Simon R Bramhall, Darius F Mirza
Affiliations

A preoperative predictive score of pancreatic fistula following pancreatoduodenectomy

Keith J Roberts et al. HPB (Oxford). 2014 Jul.

Abstract

Background: Various factors are related to the occurrence of postoperative pancreatic fistula (POPF) following pancreatoduodenectomy (PD). Some of the strongest are identified intra- or postoperatively, which limits their utility in predicting this complication. The preoperative prediction of POPF permits an individualized approach to patient consent and selection, and may influence postoperative management. This study sought to develop and test a score to predict POPF.

Methods: A post hoc analysis of a prospectively maintained database was conducted. Consecutive patients were randomly selected to modelling and validation sets at a ratio of 2 :1, respectively. Patient data, preoperative blood tests and physical characteristics of the gland (assessed from preoperative computed tomography images) were subjected to univariate and multivariate analysis in the modelling set of patients. A score predictive of POPF was designed and tested in the validation set.

Results: Postoperative pancreatic fistula occurred in 77 of 325 (23.7%) patients. The occurrence of POPF was associated with 12 factors. On multivariate analysis, body mass index and pancreatic duct width were independently associated with POPF. A risk score to predict POPF was designed (area under the receiver operating characteristic curve: 0.832, 95% confidence interval 0.768-0.897; P < 0.001) and successfully tested upon the validation set.

Conclusions: Preoperative assessment of a patient's risk for POPF is possible using simple measurements. The present risk score is a valid tool with which to predict POPF in patients undergoing PD.

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Figures

Figure 1
Figure 1
Receiver operating characteristic curve of risk score in the modelling set
Figure 2
Figure 2
Comparison between the scoring system and observed rates of postoperative pancreatic fistula (POPF). The performance of the risk score in both the modelling and validation cohorts is demonstrated with the actual observed rate of POPF; bars represent 95% confidence intervals (CIs). There were twice as many patients within the modelling group (divided into deciles) as the validation group (divided into quintiles). The solid line indicates the perfect performance of the score; the dashed lines indicate the 95% CI
Figure 3
Figure 3
Graphical representation of risk for postoperative pancreatic fistula (POPF) as predicted by the risk score. Pancreatic duct width was measured from preoperative computed tomography imaging. BMI, body mass index
See this image and copyright information in PMC

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References

    1. Balzano G, Zerbi A, Capretti G, Rocchetti S, Capitanio V, Di Carlo V. Effect of hospital volume on outcome of pancreaticoduodenectomy in Italy. Br J Surg. 2008;95:357–362. - PubMed
    1. de Wilde RF, Besselink MG, van der Tweel I, de Hingh IH, van Eijck CH, Dejong CH, et al. Impact of nationwide centralization of pancreaticoduodenectomy on hospital mortality. Br J Surg. 2012;99:404–410. - PubMed
    1. Schmidt CM, Turrini O, Parikh P, House MG, Zyromski NJ, Nakeeb A, et al. Effect of hospital volume, surgeon experience, and surgeon volume on patient outcomes after pancreaticoduodenectomy: a single-institution experience. Arch Surg. 2010;145:634–640. - PubMed
    1. van Heek NT, Kuhlmann KF, Scholten RJ, de Castro SM, Busch OR, van Gulik TM, et al. Hospital volume and mortality after pancreatic resection: a systematic review and an evaluation of intervention in the Netherlands. Ann Surg. 2005;242:781–788. - PMC - PubMed
    1. Aroori S, Puneet P, Bramhall SR, Muiesan P, Mayer AD, Mirza DF, et al. Outcomes comparing a pancreaticogastrostomy (PG) and a pancreaticojejunostomy (PJ) after a pancreaticoduodenectomy (PD) HPB. 2011;13:723–731. - PMC - PubMed

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