External validation of postoperative pancreatic fistula prediction scores in pancreatoduodenectomy: a systematic review and meta-analysis

Pandé, Rupaly; Halle‐Smith, James; Phelan, Liam; Thorne, Thomas; Panikkar, Mohini; Hodson, James; Roberts, Keith; Arshad, Ali; Connor, Saxon; Conlon, Kevin C.; Dickson, Euan J.; Giovinazzo, Francesco; Harrison, Ewen M; Carino, Nicola de Liguori; Hore, Todd; Knight, Stephen R; Loveday, Benjamin; Magill, Laura; Mirza, Darius F.; Pandanaboyana, Sanjay; Perry, Rita; Pinkney, Thomas; Siriwardena, Ajith K.; Satoi, Sohei; Skipworth, James; Stättner, Stefan; Sutcliffe, Robert P.; Tingstedt, Bobby

doi:10.1016/j.hpb.2021.10.006

Cited by 22 publications

(33 citation statements)

References 63 publications

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“…Temporally, Yamamoto et al were the first to develop a prediction model for POPF in 2011, but their model did not receive wide-spread utilization, probably due to variables that were difficult to assess, such as duct diameter/pancreatic thickness—index and their obscure “away from portal vein”—variable, as well as suboptimal performance upon external validation studies (pooled AUROC 0.61). 66…”

Section: Prediction Models For Popf After Pdmentioning

confidence: 99%

“…In a systematic review by Pande et al, 66 all prediction models for POPF after PD published before 2020 were analyzed for their performance in external validation studies. It turned out, that while the AUROC-values in the original development studies for some models were reported to be very high, for example, 0.94 for FRS, the pooled AUROC values from all external validation studies were 0.71 for FRS and 0.72 for ua-FRS (which performed the best).…”

Section: Prediction Models For Popf After Pdmentioning

confidence: 99%

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Prediction of postoperative pancreatic fistula and pancreatitis after pancreatoduodenectomy or distal pancreatectomy: A review

Bonsdorff

Sallinen

2023

Scand J Surg

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Background and objective: Postoperative pancreatic fistula (POPF) is the leading cause of morbidity and early mortality in patients undergoing pancreatic resection. In addition, recent studies have identified postoperative acute pancreatitis (POAP) as an independent contributor to morbidity. Most perioperative mitigation strategies experimented for POPF have been shown to be in vain with no consensus on the best perioperative management. Clinical prediction models have been developed with the hope of identifying high POPF risk patients with the leading idea of finding subpopulations possibly benefiting from pre-existing or novel mitigation strategies. The aim of this review was to map out the existing prediction modeling studies to better understand the current stage of POPF prediction modeling, and the methodology behind them. Methods: A narrative review of the existing POPF prediction model studies was performed. Studies published before September 2022 were included. Results: While the number of POPF prediction models for pancreatoduodenectomy has increased, none of the currently existing models stand out from the crowd. For distal pancreatectomy, two unique POPF prediction models exist, but due to their freshness, no further external validation or adoption in clinics or research has been reported. There seems to be a lack of adherence to correct methodology or reporting guidelines in most of the studies, which has rendered external validity—if assessed—low. Few of the most recent studies have demonstrated preoperative assessment of pancreatic aspects from computed tomography (CT) scans to provide relatively strong predictors of POPF. Conclusions: Main goal for the future would be to reach a consensus on the most important POPF predictors and prediction model. At their current state, few models have demonstrated adequate transportability and generalizability to be up to the task. Better understanding of POPF pathophysiology and the possible driving force of acute inflammation and POAP might be required before such a prediction model can be accessed.

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Section: Prediction Models For Popf After Pdmentioning

confidence: 99%

Section: Prediction Models For Popf After Pdmentioning

confidence: 99%

Prediction of postoperative pancreatic fistula and pancreatitis after pancreatoduodenectomy or distal pancreatectomy: A review

Bonsdorff

Sallinen

2023

Scand J Surg

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“…No entanto, não é possível calcular a probabilidade de ocorrência de fístula, mas apenas distinguir pacientes de alto e baixo risco. A performance desse escore não foi adequada em estudo de validação externa, que demonstrou uma área sob a curva de 0,61 com IC 95% de 0,42 a 0,80 59 .…”

Section: Risco Para Fístula Pancreática -Análise Univariadaunclassified

“…Estudando apenas variáveis pré-operatórias, Roberts et al 34 identificaram apenas duas variáveis de risco independentes: IMC e diâmetro do ducto pancreático (aferido em exames de TC), o que permitiu desenvolver um escore de risco logístico e, portanto, estimar a probabilidade de haver FPs. Apesar da boa performance tanto na validação interna, quanto na externa 59 , o escore é de difícil cálculo, pois exige uso de formas complexas, calculadas apenas em programas de estatística. Além disso, os autores não fizeram qualquer tentativa de avaliar a composição ou consistência do parênquima pancreático, característica identificada como importante para o desenvolvimento de FP em vários estudos 30,[35][36][37][38][39][40][41] .…”

Section: Risco Para Fístula Pancreática -Análise Univariadaunclassified

“…Por isso, alguns autores propuseram modificações e excluíram o sangramento como fator de risco 35,[68][69][70] . Apesar da boa performance, inclusive em estudo de validação externa 59 , seu ponto fraco é sua inaplicabilidade pré-operatória, de forma que não se pode utilizá-lo para selecionar pacientes de alto risco para estudos de medidas que previnam as FPs ou para alterar condutas clínicas, como prescindir de drenos abdominais em casos com risco muito baixo 70 .…”

Section: Risco Para Fístula Pancreática -Análise Univariadaunclassified

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Fatores de risco associados às fístulas pancreáticas em duodenopancreatectomias: desenvolvimento e validação interna de nomograma pré-operatório

Namur¹

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Aos meus pais, Roberto e Lizette, pela dedicação, carinho, afeto e constante incentivo, sem os quais nenhuma de minhas realizações seria possível.Ao meu irmão, Alexandre, meu melhor amigo e maior exemplo de determinação e força de vontade. À minha madrinha, tia e amiga, Miriam, que sempre olhou o melhor em mim. Aos meus avós, William, Novart, Laurice e Gabriel, que pavimentaram minha estrada até aqui e vivem na memória de quem sempre os amará. Aos meus tios-avós, Jenny, Georgina e Walter, que me deram o privilégio de ter mais três avós. À minha esposa, Rafaela, por me ajudar na correção desta tese, e, principalmente, por estar a meu lado e fazer com que eu queira ser sempre uma pessoa melhor. Ao meu orientador, Prof. Dr. Ulysses Ribeiro Jr., pelo constante incentivo e direção em todas as etapas deste trabalho. Ao Prof. Dr. Ricardo Jureidini, pelos muitos anos de amizade, pelo tanto que me ensinou e pelas contribuições fundamentais para este trabalho. Ao Prof. Dr. Manoel Rocha e à Dra. Fernanda Mazzucato, pela colaboração indispensável na revisão dos exames de imagem. Ao Prof. Ivan Cecconello, mestre desde os tempos de faculdade; ao Prof. Telesforo Bacchella, chefe e amigo desde a residência; ao Prof. Sérgio Nahas, um dos grandes incentivadores de minha carreira; e ao Prof. Luiz Augusto Carneiro D'Albuquerque, pelos conselhos na elaboração deste trabalho. Ao Dr. Thiago Ribeiro, grande amigo; à Profa. Dra. Estela Figueira; e aos demais colegas do Serviço de Cirurgia de Vias Biliares e Pâncreas. À Profa. Dra. Cristina Pires Camargo, cuja ajuda foi fundamental para elaboração do nomograma. Ao Sr. Rogério Prado, pelo trabalho estatístico, que é o cerne desta pesquisa. Aos professores José Jukemura, Carlos Frederico Marques e André Roncon, pela revisão minuciosa durante o exame de qualificação. Aos meus amigos Flávio Kawamoto, Rodrigo Ambar, Allan Garms, pelos muitos anos de amizade e incentivo na elaboração desta tese. À Sra. Vilma Libério, pelo suporte desde minha matrícula até o depósito da tese. E aos demais colegas das Disciplinas de Cirurgia do Aparelho Digestivo e Coloproctologia.Esta tese está de acordo com as seguintes normas, em vigor no momento desta publicação: Referências: adaptado de International Committee of Medical Journals Editors (Vancouver).

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Development and Validation of a Model for Postpancreatectomy Hemorrhage Risk

Birgin,

Hempel,

Reeg

et al. 2023

JAMA Netw Open

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ImportancePostpancreatectomy hemorrhage (PPH) due to postoperative pancreatic fistula (POPF) is a life-threatening complication after pancreatoduodenectomy. However, there is no prediction tool for early identification of patients at high risk of late PPH.ObjectiveTo develop and validate a prediction model for PPH.Design, Setting, and ParticipantsThis retrospective prognostic study included consecutive patients with clinically relevant POPF who underwent pancreatoduodenectomy from January 1, 2009, to May 20, 2023, at the University Hospital Mannheim (derivation cohort), and from January 1, 2012, to May 31, 2022, at the University Hospital Dresden (validation cohort). Data analysis was performed from May 30 to July 29, 2023.ExposureClinical and radiologic features of PPH.Main Outcomes and MeasuresAccuracy of a predictive risk score of PPH. A multivariate prediction model—the hemorrhage risk score (HRS)—was established in the derivation cohort (n = 139) and validated in the validation cohort (n = 154).ResultsA total of 293 patients (187 [64%] men; median age, 69 [IQR, 60-76] years) were included. The HRS comprised 4 variables with associations: sentinel bleeding (odds ratio [OR], 35.10; 95% CI, 5.58-221.00; P &lt; .001), drain fluid culture positive for Candida species (OR, 14.40; 95% CI, 2.24-92.20; P &lt; .001), and radiologic proof of rim enhancement of (OR, 12.00; 95% CI, 2.08-69.50; P = .006) or gas within (OR, 12.10; 95% CI, 2.22-65.50; P = .004) a peripancreatic fluid collection. Two risk categories were identified with patients at low risk (0-1 points) and high risk (≥2 points) to develop PPH. Patients with PPH were predicted accurately in the derivation cohort (C index, 0.97) and validation cohort (C index 0.83). The need for more invasive PPH management (74% vs 34%; P &lt; .001) and severe complications (49% vs 23%; P &lt; .001) were more frequent in high-risk patients compared with low-risk patients.Conclusions and RelevanceIn this retrospective prognostic study, a robust prediction model for PPH was developed and validated. This tool may facilitate early identification of patients at high risk for PPH.

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External validation of postoperative pancreatic fistula prediction scores in pancreatoduodenectomy: a systematic review and meta-analysis

Cited by 22 publications

References 63 publications

Prediction of postoperative pancreatic fistula and pancreatitis after pancreatoduodenectomy or distal pancreatectomy: A review

Prediction of postoperative pancreatic fistula and pancreatitis after pancreatoduodenectomy or distal pancreatectomy: A review

Fatores de risco associados às fístulas pancreáticas em duodenopancreatectomias: desenvolvimento e validação interna de nomograma pré-operatório

Development and Validation of a Model for Postpancreatectomy Hemorrhage Risk

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