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Development and Validation of a New Nomogram for Predicting Clinically Relevant Postoperative Pancreatic Fistula After Pancreatoduodenectomy

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Abstract

Background

There lacks an ideal model for accurately predicting clinically relevant postoperative pancreatic fistula (CR-POPF) after pancreatoduodenectomy (PD). This study aimed at developing a nomogram with high accuracy in predicting CR-POPF after PD.

Methods

A total of 1182 patients undergoing PD in the First Affiliated Hospital of Sun Yat-sen University (FAHSYSU, n = 762) and Fudan University Shanghai Cancer Center (FUSCC, n = 420) between January 2010 and May 2018 were enrolled. The patients from FAHSYSU were assigned as testing cohort, and those from FUSCC were used as external validation cohort. Univariate and multivariate logistic regression analyses were performed to determine the predictive factors for CR-POPF. Nomogram was developed on the basis of significant predictors. The performance of nomogram was evaluated by area under receiver operating characteristic (ROC) curve (AUC), calibration curve, and decision curve analysis.

Results

In testing cohort, 87 out of 762 patients developed CR-POPF. Three predictors were significantly associated with CR-POPF, including body mass index ≥24.0 kg/m2, pancreatic duct diameter <3 mm, and drainage fluid amylase on postoperative day 1 ≥2484 units/L (all p ≤ 0.001). Prediction of nomogram was accurate with AUC of 0.934 (95% confidence interval [CI]: 0.914–0.950) in testing cohort and 0.744 (95% CI: 0.699–0.785) in external validation cohort. The predictive accuracy of nomogram was better than that of previously proposed fistula risk scores both in testing and external validation cohort (all p < 0.05).

Conclusions

The novel nomogram based on three easily available parameters could accurately predict CR-POPF after PD. It would have high clinical value due to its accuracy and convenience.

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Author notes

  1. Xi-Tai Huang, Chen-Song Huang, Chen Liu have contributed equally to this article.

Authors and Affiliations

  1. Department of Pancreato-Biliary Surgery, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, China

    Xi-Tai Huang, Chen-Song Huang, Wei Chen, Jian-Peng Cai, Li-Jian Liang & Xiao-Yu Yin

  2. Department of Pancreatic Surgery, Shanghai Cancer Center, Fudan University, 270 DongAn Road, Xuhui, Shanghai, 200032, China

    Chen Liu, He Cheng & Xian-Jun Yu

  3. Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China

    Chen Liu, He Cheng & Xian-Jun Yu

  4. Shanghai Pancreatic Cancer Institute, Shanghai, China

    Chen Liu, He Cheng & Xian-Jun Yu

  5. Department of Hepatobiliary Surgery, The Affiliated Xinyu Hospital, Nanchang University, Xinyu, 338025, China

    Xing-Xing Jiang

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  1. Xi-Tai Huang
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  2. Chen-Song Huang
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  4. Wei Chen
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  8. Li-Jian Liang
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Correspondence to Xian-Jun Yu or Xiao-Yu Yin.

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Huang, XT., Huang, CS., Liu, C. et al. Development and Validation of a New Nomogram for Predicting Clinically Relevant Postoperative Pancreatic Fistula After Pancreatoduodenectomy. World J Surg 45, 261–269 (2021). https://doi.org/10.1007/s00268-020-05773-y

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  • DOI: https://doi.org/10.1007/s00268-020-05773-y

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