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A Novel Pancreatic Fistula Risk Score Including Preoperative Radiation Therapy in Pancreatic Cancer Patients

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Postoperative pancreatic fistula (POPF) is the most serious complication following pancreaticoduodenectomy (PD). Identifying patients at high or low risk of developing POPF is important in perioperative management. This study aimed to determine a predictive risk score for POPF following PD, and compare it to preexisting scores.

Methods

All patients who underwent open PD from 2012 to 2017 in two high-volume centers were included. The training dataset was used for the development of the POPF predictive risk score (using the 2016 ISGPS definition), while the testing dataset was used for external validation. The proposed score was compared to the fistula risk score (FRS), the NSQIP-modified FRS (mFRS), and the alternative FRS (aFRS).

Results

Overall, 448 and 213 patients were included in the training and testing datasets, respectively. A probabilistic predictive risk score was developed using four independent POPF risk factors (increasing age, no preoperative radiation therapy, soft pancreatic stump, and decreasing main pancreatic duct diameter). The discriminative capacities of the new score, FRS, mFRS, and aFRS were similar (AUC ranging from 0.73 to 0.79 in the training cohort and from 0.73 to 0.76 in the testing cohort). However, the new score identified more specifically patients at low risk of POPF compared with other scores, in both cohorts, with a 6% false-negative rate.

Conclusions

Preoperative radiation therapy is an independent protective factor of POPF following PD. It should be included in the risk score of POPF to identify more precisely patients at low risk for this complication.

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Abbreviations

PD:

Pancreaticoduodenectomy

POPF:

Postoperative pancreatic fistula

FRS:

Fistula risk score

mFRS:

Modified FRS

aFRS:

Alternative FRS

ISGPS:

International Study Group on Pancreatic Surgery

BJN:

Beaujon University Hospital

IPC:

Institute Paoli Calmettes

AUC:

Area under the receiver-operating curve

BMI:

Body mass index

MPD:

Main pancreatic duct

ASA:

American Society of Anesthesiologists

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Authors and Affiliations

  1. Department of HPB Surgery, Hôpital Beaujon, Paris, France

    Nicolas Tabchouri MD, Hélène Hermand MD, Olivier Benoit MD, Safi Dokmak MD, PhD, Béatrice Aussilhou MD, Sébastien Gaujoux MD, PhD & Alain Sauvanet MD

  2. Department of Digestive Surgery, Hôpital Trousseau, Tours, France

    Nicolas Tabchouri MD

  3. Department of Digestive Surgery, Institut Paoli Calmettes, Marseille, France

    Morgane Bouquot MD, Olivier Turrini MD, PhD & Jean Robert Delpero MD

  4. DynFluid Laboratory, Arts et Métiers Paris Tech, Paris, France

    Jean-Christophe Loiseau PhD

  5. University Paris, Paris, France

    Alain Sauvanet MD

  6. AP-HP, Department of HBP Surgery, DIGEST Medico-Universitary Department, Hôpital Beaujon APHP, 100 boulevard du Général Leclerc, 92110, Clichy, France

    Alain Sauvanet MD

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Contributions

As per the guidelines of the International Committee of Medical Journal Editors (ICMJE), all authors must meet all of the following criteria:

1. Substantial contributions to the conception or design of the work (NT, JCL, AS) or the acquisition (MB, HH, OB, SD, BA, OT, JRD), analysis (NT, JCL), or interpretation of data for the work (MB, JCL, SG, OT, JRD, AS), and

2. Drafting the work (MB, AS) or revising it critically for important intellectual content (all other authors), and

3. Final approval of the version to be published (all authors), and

4. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved (all authors).

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Correspondence to Alain Sauvanet MD.

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This paper was presented as oral communication at the 13th IHPBA meeting, 4–7th September 2018, Geneva, Switzerland.

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Tabchouri, N., Bouquot, M., Hermand, H. et al. A Novel Pancreatic Fistula Risk Score Including Preoperative Radiation Therapy in Pancreatic Cancer Patients. J Gastrointest Surg 25, 991–1000 (2021). https://doi.org/10.1007/s11605-020-04600-y

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  • DOI: https://doi.org/10.1007/s11605-020-04600-y

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