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Validation of original, alternative, and updated alternative fistula risk scores after open and minimally invasive pancreatoduodenectomy in an Asian patient cohort

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Abstract

Background

This study aimed to validate and compare the performance of the original fistula risk scores (o-FRS), alternative (a-FRS), and updated alternative FRS (ua-FRS) after open pancreatoduodenectomy (OPD) and laparoscopic pancreatoduodenectomy (LPD) in an Asian patient cohort.

Methods

Data of 597 consecutive patients who underwent PD (305 OPD, 274 LPD) were collected from two tertiary centers. Model performance was assessed using the area under the receiver operating curve (AUC).

Results

The overall AUC values of o-FRS, a-FRS, and ua-FRS were 0.67, 0.69, and 0.68, respectively, which were lower than those of the Western validation. Three FRS systems had similar AUC values in the overall and OPD groups, whereas ua-FRS had a higher AUC than o-FRS in the LPD group. The accuracy of ua-FRS (47.2%) was higher than that of o-FRS (39.0%) and a-FRS (19.5%) overall, but low specificity and low positive predictive value were observed regardless of the operative type across the three FRS systems. In the multivariate analysis, pathology, estimated blood loss, and body mass index were not independent risk factors for CR-POPF in the OPD and LPD groups.

Conclusions

Current FRS systems have some limitations, including a relatively lower performance in an Asian cohort, low positive predictive values, and inclusion of insignificant risk factors.

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Authors and Affiliations

  1. Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea

    Boram Lee, Yoo-Seok Yoon, Jun Suh Lee, Jai Young Cho & Ho-Seong Han

  2. Division of Hepatobiliary Pancreatic Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

    Chang Moo Kang, Munseok Choi, Ho Kyoung Hwang & Woo Jung Lee

Authors
  1. Boram Lee
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  2. Yoo-Seok Yoon
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  3. Chang Moo Kang
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  4. Munseok Choi
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  5. Jun Suh Lee
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  6. Ho Kyoung Hwang
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Contributions

Conception and design: All authors, Administrative support: All authors, Provision of study materials or patients: All authors, Collection and assembly of data: BL. YSY, and CMK, Data analysis and interpretation: BL. YSY, and CMK, Manuscript writing: All authors, and Final approval of manuscript: All authors.

Corresponding authors

Correspondence to Yoo-Seok Yoon or Chang Moo Kang.

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Disclosures

Boram Lee, Yoo-Seok Yoon, Chang Moo Kang, Munseok Choi, Jun Suh Lee, Ho Kyoung Hwang, Jai Young Cho, Woo Jung Lee, and Ho-Seong Han have no conflicts of interest or financial ties to disclosure.

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Lee, B., Yoon, YS., Kang, C.M. et al. Validation of original, alternative, and updated alternative fistula risk scores after open and minimally invasive pancreatoduodenectomy in an Asian patient cohort. Surg Endosc 37, 1822–1829 (2023). https://doi.org/10.1007/s00464-022-09633-9

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  • DOI: https://doi.org/10.1007/s00464-022-09633-9

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