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Prospective study on predictability of complications by pancreatic surgeons

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Abstract

Purpose

We evaluated the intuition of expert pancreatic surgeons, in predicting the associated risk of pancreatic resection and compared this “intuition” to actual operative follow-up. The objective was to avoid major complications following pancreatic resection, which remains a challenge.

Methods

From January 2015 to February 2018, all patients who were 18 years old or more undergoing a pancreatic resection (pancreaticoduodenectomy [PD], distal pancreatectomy [DP], or central pancreatectomy [CP]) for pancreatic lesions were included. Preoperatively and postoperatively, all surgeons completed a form assessing the expected potential occurrence of clinically relevant postoperative pancreatic fistula (CR-POPF: grade B or C), postoperative hemorrhage, and length of stay.

Results

Preoperative intuition was assessed for 101 patients for 52 PD, 44 DP, and 5 CP cases. Overall mortality and morbidity rates were 6.9% (n = 7) and 67.3% (n = 68), respectively, and 38 patients (37.6%) developed a POPF, including 27 (26.7%) CR-POPF. Concordance between preoperative intuition of CR-POPF occurrence and reality was minimal, with a Cohen’s kappa coefficient (κ) of 0.175 (P value = 0.009), and the same result was obtained between postoperative intuition and reality (κ = 0.351; P < 0.001). When the pancreatic parenchyma was hard, surgeons predicted the absence of CR-POPF with a negative predictive value of 91.3%. However, they were not able to predict the occurrence of CR-POPF when the pancreas was soft (positive predictive value 48%).

Conclusions

This study assessed for the first time the surgeon’s intuition in pancreatic surgery, and demonstrated that pancreatic surgeons cannot accurately assess outcomes except when the pancreatic parenchyma is hard.

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Authors and Affiliations

  1. Department of Digestive Surgery, Hospital Nord, Aix-Marseille University, Chemin des Bourrely, 13015, Marseille, France

    Charles Vanbrugghe, David Jérémie Birnbaum, Théophile Guilbaud, Stéphane Victor Berdah & Vincent Moutardier

  2. EA 3279 - Self-perceived Health Assessment Research Unit, Aix-Marseille University, 13005, Marseille, France

    Mohamed Boucekine

  3. Department of Digestive Surgery and Oncology, Institut Paoli Calmettes, 232 Boulevard Sainte Marguerite, 13009, Marseille, France

    Jacques Ewald & Ugo Marchese

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  1. Charles Vanbrugghe
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  2. David Jérémie Birnbaum
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  3. Mohamed Boucekine
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Correspondence to Charles Vanbrugghe.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Vanbrugghe, C., Birnbaum, D.J., Boucekine, M. et al. Prospective study on predictability of complications by pancreatic surgeons. Langenbecks Arch Surg 405, 155–163 (2020). https://doi.org/10.1007/s00423-020-01866-3

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