Intraoperative Fistula Risk Score In Pancreatoduodenectomy (i-FRS): Development and Validation In International Multicenter Datasets

Mungroop, Timothy H.; Rijssen, B. van; Klaveren, David van; Smits, J.; Woerden, Victor van; Linnemann, R.; Ecker, Brett L.; Bonsing, Bert A.; Busch, Olivier R.; Dam, Ronald M. van; Erdmann, J.; Eijck, Casper van; Gerhards, Michael F.; Goor, Harry van; Harst, Erwin van der; Hingh, Ignace de; Jong, Kim de; Besselink, Marc G.

doi:10.1016/j.pan.2017.05.231

Cited by 49 publications

(105 citation statements)

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“…Although some studies have revealed that BMI [21,22] and intraoperative blood loss [7,25] were risk factors for POPF, we failed to confirm this in our patient group. Asian patients normally have a lower BMI compared with Western people [26].…”

Section: Discussioncontrasting

confidence: 72%

“…In the present study, this factor was seen to have the most potent influence on the development of POPF, with its OR of above 3. The size of the main pancreatic duct is also a well-accepted risk factor for POPF, and always has a relatively high OR [10,21,23]. Since the PJ technique used can be largely dependent on the size of the main pancreatic duct, we speculate that the preference of surgeons for a certain PJ technique could affect the weight of the size of the pancreatic duct in predictive models.…”

Section: Discussionmentioning

confidence: 96%

“…Most of these factors were well-known risk factors for POPF using the 2005 definition, except portal vein invasion, which was infrequently reported specifically as a risk factor for POPF after PD [22][23][24]. In addition to the fact that many studies did not include portal vein invasion as a candidate risk factor [21], whether portal vein invasion was seen to be a risk factor may have been affected by the proportion of patients with malignancies and venous invasion in the cohort in question. For instance, in the study by Yamamoto et al [10], incidences of pancreatic cancer (51.9%) and portal vein invasion (21.4%) were reported that were similar to those in our patient group (49.3% and 27.2%, respectively).…”

Section: Discussionmentioning

confidence: 99%

“…To compare our nomogram with previously reported models, we tested 2 validated models (generated by Callery et al [7] and Mungroop et al [21]) using the validation cohort. The C-indexes of Callery's and Mungroop's models were 0.706 and 0.789, respectively (Fig.…”

Section: Comparisons Between the Nomogram And Existing Models Using Tmentioning

confidence: 99%

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Prediction of postoperative pancreatic fistula using a nomogram based on the updated definition

et al. 2020

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The International Study Group on Pancreatic Fistula's definition of postoperative pancreatic fistula (POPF) has recently been updated. This study aimed to identify risk factors for POPF in patients having pancreaticoduodenectomy (PD) and to generate a nomogram to predict POPF. Methods: Data on 298 patients who underwent PD from March 2012 to October 2017 was retrospectively reviewed and POPF statuses were redefined. A nomogram was constructed using data from 220 patients and validated using the remaining 78 patients. Independent risk factors for POPF were identified using univariate and multivariate analyses. A predictive nomogram was established based on the independent risk factors and was compared with existing models. Results: Texture of the pancreas, size of the main pancreatic duct, portal vein invasion, and definitive pathology were the identified risk factors. The nomogram had a C-index of 0.793 and was internally validated. The nomogram performed better (C-index of 0.816) than the other most cited models (C-indexes of 0.728 and 0.735) in the validation cohort. In addition, the nomogram can assign patients into low-(less than 10%), intermediate-(10% to 30%), and high-risk (equal or higher than 30%) groups to facilitate personalized management. Conclusion: The nomogram accurately predicted POPF in patients having PD.

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Section: Discussioncontrasting

confidence: 72%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Comparisons Between the Nomogram And Existing Models Using Tmentioning

confidence: 99%

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Prediction of postoperative pancreatic fistula using a nomogram based on the updated definition

et al. 2020

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“…2a). 13 Patients with SEMS had a shorter mean length of hospital stay than patients with plastic stents (14.0 days (SE 0.6) vs. 17.4 days (SE 1.0) respectively, p = 0.005). In multivariable linear regression, adjusted for patient characteristics, hospital volume, site of origin, neoadjuvant therapy, pancreatic texture, and major postoperative complications, length of hospital stay was almost three days shorter in patients who received a SEMS (B −2.86 95% CI -5.16-0.57, p = 0.014) compared to patients with a plastic stent (Fig.…”

Section: Postoperative Outcomes After Pancreatoduodenectomymentioning

confidence: 87%

Nationwide Practice and Outcomes of Endoscopic Biliary Drainage in Resectable Pancreatic Head and Periampullary Cancer

et al. 2020

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Background: Guidelines advise self-expanding metal stents (SEMS) over plastic stents in preoperative endoscopic biliary drainage (EBD) for malignant extrahepatic biliary obstruction. This study aims to assess nationwide practice and outcomes. Methods: Patients with pancreatic head and periampullary cancer who underwent EBD before pancreatoduodenectomy were included from the Dutch Pancreatic Cancer Audit (2017-2018). Multivariable logistic and linear regression models were performed. Results: In total, 575/1056 patients (62.0%) underwent preoperative EBD: 246 SEMS (42.8%) and 329 plastic stents (57.2%). EBD-related complications were comparable between the groups (44/246 (17.9%) vs. 64/329 (19.5%), p = 0.607), including pancreatitis (22/246 (8.9%) vs. 25/329 (7.6%), p = 0.387). EBD-related cholangitis was reduced after SEMS placement (10/246 (4.1%) vs. 32/329 (9.7%), p = 0.043), which was confirmed in multivariable analysis (OR 0.36 95%CI 0.15-0.87, p = 0.023). Major postoperative complications did not differ (58/246 (23.6%) vs. 90/329 (27.4%), p = 0.316), whereas postoperative pancreatic fistula (24/246 (9.8%) vs. 61/329 (18.5%), p = 0.004; OR 0.50 95%CI 0.27-0.94, p = 0.031) and hospital stay (14.0 days vs. 17.4 days, p = 0.005; B 2.86 95%CI −5.16 to −0.57, p = 0.014) were less after SEMS placement. Conclusion: This study found that preoperative EBD frequently involved plastic stents. SEMS seemed associated with lower risks of cholangitis and less postoperative pancreatic fistula, but without an increased pancreatitis risk.

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Prognostic Value of Pancreatic Fistula in Resected Patients With Pancreatic Cancer With Neoadjuvant Therapy

Shi

Hua

2020

JAMA Surg

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To the Editor We have read with great interest the article by Petro and Rosen regarding the elegantly titled "Bouffant Scandal." 1 In the era of evidence-based medicine, the heated debate about which surgical cap should adorn the heads of surgeons is, rather surprisingly, laden with nonscientific, sometimes petty and disingenuous arguments. The purpose of generating clinical practice guidelines is the promotion of an evidence-based delivery of health care and reduction of inappropriate variations in practice. 2 The process of guideline generation is not a straightforward one and, as we have shown, 3 in complex diseases such as traumatic brain injury, the effort of generating meaningful guidelines may sometimes be hampered by the way evidence is translated into recommendations. Difficulties in translating evidence as well as a poor evidence base itself lead to volatile recommendations, with low survival from one edition of the guidelines to the other. 3 In the preview of the Association of peri-Operative Registered Nurses (AORN) 2019 Guidelines, no recommendation could be made for the type of covers to be worn in restricted and semirestricted areas because the evidence does not demonstrate any association between the type of surgical head covering material or extent of hair coverage and surgical site infection (SSI) rates. 1 Formulating the recommendation in this manner seems to suggest that the evidence is lacking, which is not the case. A positive interpretation of the evidence would be to suggest that all of the studied surgical caps may be used because none shows a higher association to SSIs. Rather more worrisome is the recommendation that an interdisciplinary team, including members of the surgical team and infection preventionists, may determine the type of head covers that will be worn. The guideline committee has synthetized evidence, drawn conclusions, and formally recommends that another committee may redo this process, which suggests that different interpretations of the evidence may yield different results. Mechanistic reasoning (such as hair being contaminated with bacteria, which may increase the prevalence rate of SSI) has often been disproved when being tested in clinical trials and should not form the only basis of discounting the available studies. 4 Mechanistic models are often too simplistic to apply in a clinical setting. Patient safety should always be paramount, but the enormous burden of administrative duties the modern surgeon faces 5 may deter from this very objective, and guidelines should be, among others, a tool meant to ease this burden, not augment it.

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Intraoperative Fistula Risk Score In Pancreatoduodenectomy (i-FRS): Development and Validation In International Multicenter Datasets

Cited by 49 publications

References 0 publications

Prediction of postoperative pancreatic fistula using a nomogram based on the updated definition

Prediction of postoperative pancreatic fistula using a nomogram based on the updated definition

Nationwide Practice and Outcomes of Endoscopic Biliary Drainage in Resectable Pancreatic Head and Periampullary Cancer

Prognostic Value of Pancreatic Fistula in Resected Patients With Pancreatic Cancer With Neoadjuvant Therapy

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