• Thijs J Schouten, Anne Claire Henry, Francina J Smits, Marc G Besselink, Bert A Bonsing, Koop Bosscha, Olivier R Busch, Ronald M van Dam, Casper H van Eijck, Sebastiaan Festen, Bas Groot Koerkamp, Erwin van der Harst, de HinghIgnace H J TIHJTGROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands.Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands., Geert Kazemier, LiemMike S LMSLDepartment of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands., Vincent E de Meijer, Gijs A Patijn, Daphne Roos, SchreinemakersJennifer M JJMJDepartment of Surgery, Amphia Hospital, Breda, The Netherlands., StommelMartijn W JMWJDepartment of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands., Fennie Wit, Lois A Daamen, Izaak Q Molenaar, Hjalmar C van Santvoort, and Dutch Pancreatic Cancer Group.
• Departments of Surgery, Regional Academic Cancer Center Utrecht, UMC Utrecht Cancer Center and St. Antonius Hospital Nieuwegein, Utrecht University, Utrecht, The Netherlands.
• Ann. Surg. 2023 Dec 1; 278 (6): 100110081001-1008.

ObjectiveTo evaluate the performance of published fistula risk models by external validation, and to identify independent risk factors for postoperative pancreatic fistula (POPF).BackgroundMultiple risk models have been developed to predict POPF after pancreatoduodenectomy. External validation in high-quality prospective cohorts is, however, lacking or only performed for individual models.MethodsA post hoc analysis of data from the stepped-wedge cluster cluster-randomized Care After Pancreatic Resection According to an Algorithm for Early Detection and Minimally Invasive Management of Pancreatic Fistula versus Current Practice (PORSCH) trial was performed. Included were all patients undergoing pancreatoduodenectomy in the Netherlands (January 2018-November 2019). Risk models on POPF were identified by a systematic literature search. Model performance was evaluated by calculating the area under the receiver operating curves (AUC) and calibration plots. Multivariable logistic regression was performed to identify independent risk factors associated with clinically relevant POPF.ResultsOverall, 1358 patients undergoing pancreatoduodenectomy were included, of whom 341 patients (25%) developed clinically relevant POPF. Fourteen risk models for POPF were evaluated, with AUCs ranging from 0.62 to 0.70. The updated alternative fistula risk score had an AUC of 0.70 (95% confidence intervals [CI]: 0.69-0.72). The alternative fistula risk score demonstrated an AUC of 0.70 (95% CI: 0.689-0.71), whilst an AUC of 0.70 (95% CI: 0.699-0.71) was also found for the model by Petrova and colleagues. Soft pancreatic texture, pathology other than pancreatic ductal adenocarcinoma or chronic pancreatitis, small pancreatic duct diameter, higher body mass index, minimally invasive resection and male sex were identified as independent predictors of POPF.ConclusionPublished risk models predicting clinically relevant POPF after pancreatoduodenectomy have a moderate predictive accuracy. Their clinical applicability to identify high-risk patients and guide treatment strategies is therefore questionable.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

23 keywords...

hide…