External validation of alternative fistula risk score (a-FRS) for predicting pancreatic fistula after pancreatoduodenectomy

Abstract

Background: The utility of the proposed alternative fistula risk score (a-FRS) for predicting risk of clinically relevant postoperative pancreatic fistula (CR-POPF) after pancreaticoduodenectomy (PD) has not been validated widely. Methods: This retrospective analysis included data of patients undergoing open and laparoscopic PD during March 2012-May 2018 in our institution. The predictive abilities of a-FRS and original-FRS were compared. Risk factors for CR-POPF were also evaluated by multivariate regression analysis. Results: Of the 370 patients, 80 (21.62%) developed CR-POPF. The incidences of CR-POPF in patients classified as low risk, intermediate risk, and high risk by a-FRS were 5.88%, 24.38%, and 57.69%, respectively (R2 = 0.97). The incidences of CR-POPF in patients classified as negligible risk, low risk, intermediate risk, and high-risk by original-FRS were 0%, 8.62%, 21.51%, and 52.50%, respectively (R2 = 0.92). The area under the ROC curve (AUC) was 0.74 for a-FRS vs. 0.70 for original-FRS. The a-FRS performed better than original-FRS for prediction of CR-POPF in open PD patients (AUC: 0.74 vs. 0.69) and was comparable with original-FRS in laparoscopic PD patients (AUC: 0.70 vs. 0.72).

Dynamic prediction for clinically relevant pancreatic fistula: a novel prediction model for laparoscopic pancreaticoduodenectomy

“…For most preoperative and intraoperative static indexes, our result shows that only a few of them could predict the occurrence of CR-POPF, apart from preoperative serum albumin and creatine levels. This is possibly due to the fact that there's still no strong consensus about the association between these factors and CR-POPF, which probably leads to the inconsistencies in the prediction models developed recently [9,10,16,18]. However, we noted that the patients who developed CR-POPF tend to have an advanced age [44,45], higher BMI [46,47], softer pancreas [48][49][50], and smaller pancreatic ducts [48,[51][52][53][54][55], were less likely to have diabetes [47,56], and were more likely to have had portal vein resection [57], which are comparable to findings of previous research.…”

“…Moreover, CR-POPF can cause abdominal infection, postoperative bleeding, and even death [6,7]. Recent studies have conventionally used some of the indexes that are constant to predict the occurrence of POPF in a static way [8][9][10]. Among them, postoperative drainage fluid amylase (DFA) and C-reactive protein-to-serum-albumin ratio (CAR) seemed to be the accurate and widely used indexes for the prediction of CR-POPF, especially in a particular time-point, in which they are suggested to be useful and critical predictive indexes [11][12][13][14].…”

Multidisciplinary Management of Postoperative Pancreatic Fistula

“…Externally validated, it has been found to effectively predict the risk of CR-POPF as well as POPF with biochemical leaks included. 30,31 pancreaticogastrostomy (PG) as an alternative to pancreaticojejunostomy (PJ), invagination versus duct-to-mucosa creation of the PJ anastomosis, and placement of pancreatic duct stents (internal or external) across the PJ anastomosis. With regard to DP, stapled closure of the pancreatic stump has emerged as an alternative to handsewn closure, and both biologic and tissue patches have been used to reinforce the transection margin.…”

Predictive nomogram for postoperative pancreatic fistula following pancreaticoduodenectomy: a retrospective study

“…However, data regarding the optimal management for the prevention of POPF have still not been established [ 11 , 12 ]. The accurate selection of patients with a high risk of POPF at an early stage is important for optimizing the perioperative management of these patients [ 6 , 9 ].…”

“…Numerous risk factors for POPF have been identified, such as sex, pancreatic texture, blood loss, and main pancreatic duct diameter; however, most of these predictors are subjective and contradictory [ 10 ]. Several predictive models have also been proposed, among which the fistula risk score and alternative fistula risk score (a-FRS) are most commonly used [ 9 , 10 ]. However, the performances of those models were recently suggested to have low predictive value for external validation [ 9 , 10 , 14 , 15 ] .…”