Nationwide validation of the distal fistula risk score (D-FRS)

Eduard A van Bodegraven^{1

2}, Femke E T den Haring^{1

2}, Britt Pollemans^{1

2}, Damaris Monselis^{1

2}, Matteo De Pastena³, Casper van Eijck⁴, Freek Daams^{1

2}, Ignace de Hingh⁵, Misha Luyer⁵, Martijn W J Stommel⁶, Hjalmar C van Santvoort⁷, S Festen⁸, J S D Mieog⁹, J Klaase¹⁰, D Lips¹¹, M M E Coolsen¹², G P van der Schelling¹³, E R Manusama¹⁴, G Patijn¹⁵, E van der Harst¹⁶, K Bosscha¹⁷, Giovanni Marchegiani³, Marc G Besselink^{18

19}

Affiliations

¹ Department of Surgery, Amsterdam UMC, Location University of Amsterdam, De Boelelaan 1117 (ZH-7F), 1081, HV, Amsterdam, the Netherlands.
² Cancer Center Amsterdam, Amsterdam, the Netherlands.
³ General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy.
⁴ Department of Surgery, Erasmus Medical Center, Rotterdam, the Netherlands.
⁵ Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands.
⁶ Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands.
⁷ Department of Surgery, Regional Academic Cancer Center Utrecht (RAKU), Utrecht, the Netherlands.
⁸ Department of Surgery, OLVG, Amsterdam, the Netherlands.
⁹ Department of Surgery, LUMC, Leiden, the Netherlands.
¹⁰ Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands.
¹¹ Department of Surgery, Medisch Spectrum Twente, Enschede, the Netherlands.
¹² Department of Surgery, Maastricht Universitair Medisch Centrum, Maastricht, the Netherlands.
¹³ Department of Gastroenterology and Hepatology, Amphia Hospital, Breda, the Netherlands.
¹⁴ Department of Surgery, Medical Center Leeuwarden, Leeuwarden, the Netherlands.
¹⁵ Department of Surgery, Isala Clinics, Zwolle, the Netherlands.
¹⁶ Department of Surgery, Maasstad Hospital, Rotterdam, the Netherlands.
¹⁷ Department of Surgery, Jeroen Bosch Hospital, Den Bosch, the Netherlands.
¹⁸ Department of Surgery, Amsterdam UMC, Location University of Amsterdam, De Boelelaan 1117 (ZH-7F), 1081, HV, Amsterdam, the Netherlands. m.g.besselink@amsterdamUMC.nl.
¹⁹ Cancer Center Amsterdam, Amsterdam, the Netherlands. m.g.besselink@amsterdamUMC.nl.

PMID: 38114826
DOI: 10.1007/s00423-023-03192-w

Nationwide validation of the distal fistula risk score (D-FRS)

Eduard A van Bodegraven et al. Langenbecks Arch Surg. 2023.

. 2023 Dec 20;409(1):14.

doi: 10.1007/s00423-023-03192-w.

Authors

Affiliations

¹ Department of Surgery, Amsterdam UMC, Location University of Amsterdam, De Boelelaan 1117 (ZH-7F), 1081, HV, Amsterdam, the Netherlands.
² Cancer Center Amsterdam, Amsterdam, the Netherlands.
³ General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy.
⁴ Department of Surgery, Erasmus Medical Center, Rotterdam, the Netherlands.
⁵ Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands.
⁶ Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands.
⁷ Department of Surgery, Regional Academic Cancer Center Utrecht (RAKU), Utrecht, the Netherlands.
⁸ Department of Surgery, OLVG, Amsterdam, the Netherlands.
⁹ Department of Surgery, LUMC, Leiden, the Netherlands.
¹⁰ Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands.
¹¹ Department of Surgery, Medisch Spectrum Twente, Enschede, the Netherlands.
¹² Department of Surgery, Maastricht Universitair Medisch Centrum, Maastricht, the Netherlands.
¹³ Department of Gastroenterology and Hepatology, Amphia Hospital, Breda, the Netherlands.
¹⁴ Department of Surgery, Medical Center Leeuwarden, Leeuwarden, the Netherlands.
¹⁵ Department of Surgery, Isala Clinics, Zwolle, the Netherlands.
¹⁶ Department of Surgery, Maasstad Hospital, Rotterdam, the Netherlands.
¹⁷ Department of Surgery, Jeroen Bosch Hospital, Den Bosch, the Netherlands.
¹⁸ Department of Surgery, Amsterdam UMC, Location University of Amsterdam, De Boelelaan 1117 (ZH-7F), 1081, HV, Amsterdam, the Netherlands. m.g.besselink@amsterdamUMC.nl.
¹⁹ Cancer Center Amsterdam, Amsterdam, the Netherlands. m.g.besselink@amsterdamUMC.nl.

PMID: 38114826
DOI: 10.1007/s00423-023-03192-w

Abstract

Purpose: Distal pancreatectomy (DP) is associated with a high complication rate of 30-50% with postoperative pancreatic fistula (POPF) as a dominant contributor. Adequate risk estimation for POPF enables surgeons to use a tailor-made approach. Assessment of the risk of POPF prior to DP can lead to the application of preventive strategies. The current study aims to validate the recently published preoperative and intraoperative distal fistula risk score (D-FRS) in a nationwide cohort.

Methods: This nationwide retrospective Dutch cohort study included all patients after DP for any indication, all of whom were registered in the Dutch Pancreatic Cancer Audit (DPCA) database between 2013 and 2021. The D-FRS was validated by filling in the probability equations with data from this cohort. The predictive capacity of the models was represented by an area under the receiver operating characteristic (AUROC) curve.

Results: A total of 896 patients underwent DP of which 152 (17%) developed POPF of whom 144 grade B (95%) and 8 grade C (5%). The preoperative D-FRS, consisting of the variables pancreatic neck thickness and pancreatic duct diameter, showed an AUROC of 0.73 (95%CI 0.68-0.78). The intraoperative D-FRS, comprising pancreatic neck, duct diameter, BMI, operating time, and soft pancreatic aspect, showed an AUROC of 0.69 (95%CI 0.64-0.74).

Conclusion: The current study is the first nationwide validation of the preoperative and intraoperative D-FRS showing acceptable distinguishing capacity for only the preoperative D-FRS for POPF. Therefore, the preoperative score could improve prevention and mitigation strategies such as drain management, which is currently investigated in the multicenter PANDORINA trial.

Keywords: Distal fistula risk score; Distal pancreatectomy; Postoperative pancreatic fistula.

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References

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Nationwide validation of the distal fistula risk score (D-FRS)

Affiliations

Nationwide validation of the distal fistula risk score (D-FRS)

Authors

Affiliations

Abstract

References

MeSH terms