Clinical validation of scoring systems of postoperative pancreatic fistula after pancreatoduodenectomy: applicability to Eastern cohorts?

Kang, Jae Seung; Park, Taesung; Han, Youngmin; Lee, Seungyeon; Kim, Jae Ri; Kim, Hongbeom; Kwon, Wooil; Kim, Sun‐Whe; Heo, Jin Seok; Choi, Seong Ho; Choi, Dong Wook; Kim, Song Cheol; Hong, Tae Ho; Yoon, Dong Sup; Park, Joon Seong; Park, Sang Jae; Han, Sung‐Sik; Choi, Se Yeon; Kim, Joo Seop; Lim, Chae‐Seok; Jang, Jin–Young

doi:10.21037/hbsn.2019.03.17

Cited by 19 publications

(14 citation statements)

References 22 publications

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“…Furthermore, the sources of heterogeneity were identified by excluding 1 study at a time. The heterogeneity decreased from I 2 = 62% to I 2 = 0% by excluding the study by Kang et al [ 28 ] in the analysis of diabetes mellitus. The result after excluding the sources of heterogeneity showed that diabetes mellitus was a significant protective factor of CR-POPF (OR = 0.51, 95% CI: 0.35–0.74, P < .001) (Supplementary Figure 4, http://links.lww.com/MD/G805 ).…”

Section: Resultsmentioning

confidence: 87%

“…The association of vascular resection and CR-POPF was assessed by 6 studies with 5462 patients. [ 20 , 21 , 28 , 32 , 33 , 36 ] There was no heterogeneity ( I 2 = 0%), so the fixed-effects model was adopted. The result showed that intraoperative vascular resection was a significant protective factor of CR-POPF (OR = 0.57, 95% CI: 0.39–0.83, P = .003) (Fig.…”

Section: Resultsmentioning

confidence: 99%

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Risk factors of clinically relevant postoperative pancreatic fistula after pancreaticoduodenectomy: A systematic review and meta-analysis

Zhang

Yuan

et al. 2022

Medicine

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Background: Clinically relevant postoperative pancreatic fistula (CR-POPF) is a common and troublesome complication after pancreatoduodenectomy (PD). We conducted a systematic review and meta-analysis to identify the risk factors of CR-POPF after PD. Methods: We searched PubMed, EMBASE, and Cochrane Library databases for studies related to risk factors of CR-POPF after PD. Odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were extracted from the included studies, then a meta-analysis was conducted. If necessary, sensitivity analysis would be performed by changing the effect model or excluding 1 study at a time. Publication bias was assessed by funnel plot and Begg test and Egger test. Results: A total of 27 studies with 24,740 patients were included, and CR-POPF occurred in 3843 patients (incidence = 17%, 95% CI: 16%–19%). Male (OR = 1.56, 95% CI: 1.42–1.70), body mass index >25 kg/m 2 (OR = 1.98, 95% CI: 1.23–3.18), pancreatic duct diameter <3 mm (OR = 1.87, 95% CI: 1.66–2.12), soft pancreatic texture (OR = 3.49, 95% CI: 2.61–4.67), and blood transfusion (OR = 3.10, 95% CI: 2.01–4.77) can significantly increase the risk of CR-POPF. Pancreatic adenocarcinoma (OR = 0.54, 95% CI: 0.47–0.61), vascular resection (OR = 0.57, 95% CI: 0.39–0.83), and preoperative chemoradiotherapy (OR = 0.68, 95% CI: 0.57–0.81) can significantly decrease the factor of CR-POPF. Diabetes mellitus was not statistically associated with CR-POPF (OR = 0.66, 95% CI: 0.40–1.08). However, the analysis of body mass index, pancreatic texture, and diabetes mellitus had a high heterogeneity, then sensitivity analysis was performed, and the result after sensitivity analysis showed diabetes mellitus can significantly decrease the risk of CR-POPF. There was no significant publication bias in this meta-analysis. Conclusions: The current review assessed the effects of different factors on CR-POPF. This can provide a basis for the prevention and management of CR-POPF. Effective interventions targeting the above risk factors should be investigated in future studies for decreasing the occurrence of CR-POPF.

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Section: Resultsmentioning

confidence: 87%

Section: Resultsmentioning

confidence: 99%

Risk factors of clinically relevant postoperative pancreatic fistula after pancreaticoduodenectomy: A systematic review and meta-analysis

Zhang

Yuan

et al. 2022

Medicine

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“…[ 26 ] To our knowledge, there is no predictive platform for POPF that includes POD1 DFA and there are limits in predicting POPF with the current known preoperative variables. [ 27 , 28 ] The development of a predictive system including POD1 DFA will be beneficial for re-evaluating the risks of POPF and patient management. Further research is also needed on the potential intrinsic risk factors including the genetic or pathologic characteristics of the patients or diseases.…”

Section: Discussionmentioning

confidence: 99%

Prophylactic octreotide for postoperative pancreatic fistula in patients with pancreatoduodenectomy

Yoon¹,

Lee²,

Jung³

et al. 2022

Medicine

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Background: Postoperative pancreatic fistula is one of the most critical complications following pancreatic surgery. This study aimed to evaluate the utility of selective prophylactic octreotide for patients at high risk of developing postoperative pancreatic fistula.Methods: From June 2019 to July 2020, 263 patients underwent pancreatoduodenectomy with pancreatojejunostomy at Samsung Medical Center. The individual fistula risk scores were calculated using a previously developed nomogram. The clinicopathological data of the patients were retrospectively reviewed.Results: There were 81 patients in the low-risk group and 182 patients in the high-risk group. No statistically significant differences were found in the rates of clinically relevant postoperative pancreatic fistula between octreotide group and the control group in all patients (15.0% vs 14.7%, P = .963) and in the high-risk group (16.1% vs 23.6%, P = .206). In risk factor analysis, postoperative octreotide was not an independent risk factor for clinically relevant pancreatic fistula in all patients and the high-risk group. Drain fluid amylase levels on the first postoperative day were significantly associated with clinically relevant postoperative pancreatic fistula, regardless of the individual risk. Conclusions:The selective use of octreotide, even in high-risk patients, showed no protective effect against pancreatic fistula. Therefore, the routine use of postoperative octreotide is not recommended. Abbreviations: ASA = American Society of Anesthesiology, BMI = body mass index, CI = confidence interval, CR-POPF = clinically relevant POPF, CT = computed tomography, DFA = drain fluid amylase, DP = distal pancreatectomy, ISGPF = International Study Group of Pancreatic Fistula, MPD = main pancreatic duct, MRCP = magnetic resonance cholangiopancreatography, OR = odds ratio, PD = pancreatoduodenectomy, POD = postoperative day, POPF = postoperative pancreatic fistula.

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“…A series of traditional risk scoring systems, such as the original fistula risk score (o-FRS) [ 5 ] and the alternative fistula risk score (a-FRS) [ 6 ], have been used. However, several studies performed external validation and the predictability varied with the study population [ 7 8 11 12 ]. Therefore, our institution suggested new predictive models using nomograms and AI [ 9 10 ] and this study validated the predictability of the new platforms with an external cohort.…”

Section: Discussionmentioning

confidence: 99%

“…Based on traditional risk factors, there were attempts to develop platforms for predicting POPF [ 5 6 ]. However, due to the limited predictive values of previous platforms [ 7 8 ], we developed new risk prediction platforms using nomograms [ 9 ] and artificial intelligence (AI) technology [ 10 ]. The nomogram consisting of 6 preoperatively available data provides a better insight into the risk factors and their contributions.…”

Section: Introductionmentioning

confidence: 99%

External validation of risk prediction platforms for pancreatic fistula after pancreatoduodenectomy using nomograms and artificial intelligence

et al. 2022

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Purpose Postoperative pancreatic fistula (POPF) is a life-threatening complication following pancreatoduodenectomy (PD). We previously developed nomogram- and artificial intelligence (AI)-based risk prediction platforms for POPF after PD. This study aims to externally validate these platforms. Methods Between January 2007 and December 2016, a total of 1,576 patients who underwent PD in Seoul National University Hospital, Ilsan Paik Hospital, and Boramae Medical Center were retrospectively reviewed. The individual risk scores for POPF were calculated using each platform by Samsung Medical Center. The predictive ability was evaluated using a receiver operating characteristic curve and the area under the curve (AUC). The optimal predictive value was obtained via backward elimination in accordance with the results from the AI development process. Results The AUC of the nomogram after external validation was 0.679 (P < 0.001). The values of AUC after backward elimination in the AI model varied from 0.585 to 0.672. A total of 13 risk factors represented the maximal AUC of 0.672 (P < 0.001). Conclusion We performed external validation of previously developed platforms for predicting POPF. Further research is needed to investigate other potential risk factors and thereby improve the predictability of the platform.

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Clinical validation of scoring systems of postoperative pancreatic fistula after pancreatoduodenectomy: applicability to Eastern cohorts?

Cited by 19 publications

References 22 publications

Risk factors of clinically relevant postoperative pancreatic fistula after pancreaticoduodenectomy: A systematic review and meta-analysis

Risk factors of clinically relevant postoperative pancreatic fistula after pancreaticoduodenectomy: A systematic review and meta-analysis

Prophylactic octreotide for postoperative pancreatic fistula in patients with pancreatoduodenectomy

External validation of risk prediction platforms for pancreatic fistula after pancreatoduodenectomy using nomograms and artificial intelligence

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