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Bodegraven, E.A. van; Haring, F.E.T. den; Pollemans, B.; Monselis, D.; Pastena, M. de; Eijck, C. van; ... ; Besselink, M.G. (2023)

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

Article / Letter to editor
PurposeDistal 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.MethodsThis 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.ResultsA total of 896 patients underwent DP of which 152 (17%) developed POPF of whom...Show morePurposeDistal 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.MethodsThis 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.ResultsA 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).ConclusionThe 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.Show less
Distal fistula risk score
Distal pancreatectomy
Postoperative pancreatic fistula
All authors
Bodegraven, E.A. van; Haring, F.E.T. den; Pollemans, B.; Monselis, D.; Pastena, M. de; Eijck, C. van; Daams, F.; Hingh, I. de; Luyer, M.; Stommel, M.W.J.; Santvoort, H.C. van; Festen, S.; Mieog, J.S.D.; Klaase, J.; Lips, D.; Coolsen, M.M.E.; Schelling, G.P. van der; Manusama, E.R.; Patijn, G.; Harst, E. van der; Bosscha, K.; Marchegiani, G.; Besselink, M.G.
Date
2023-12-20
Journal
Langenbeck's Archives of Surgery
Volume
409
Issue
1
DOI
doi:10.1007/s00423-023-03192-w
Link
https://link.springer.com/article/10.1007/s00423-023-03192-w