TY - JOUR
T1 - Alternative Fistula Risk Score for Pancreatoduodenectomy (a-FRS): Design and International External Validation
T2 - Design and International External Validation
AU - Dutch Pancreatic Cancer Group
AU - Mungroop, Timothy H.
AU - van Rijssen, L. Bengt
AU - van Klaveren, David
AU - Smits, F. Jasmijn
AU - van Woerden, Victor
AU - Linnemann, Ralph J.
AU - de Pastena, Matteo
AU - Klompmaker, Sjors
AU - Marchegiani, Giovanni
AU - Ecker, Brett L.
AU - van Dieren, Susan
AU - Bonsing, Bert
AU - Busch, Olivier R.
AU - van Dam, Ronald M.
AU - Erdmann, Joris
AU - van Eijck, Casper H.
AU - Gerhards, Michael F.
AU - van Goor, Harry
AU - van der Harst, Erwin
AU - de Hingh, Ignace H.
AU - de Jong, Koert P.
AU - Kazemier, Geert
AU - Luyer, Misha
AU - Shamali, Awad
AU - Barbaro, Salvatore
AU - Armstrong, Thomas
AU - Takhar, Arjun
AU - Hamady, Zaed
AU - Klaase, Joost
AU - Lips, Daan J.
AU - Molenaar, I. Quintus
AU - Nieuwenhuijs, Vincent B.
AU - Rupert, Coen
AU - van Santvoort, Hjalmar C.
AU - Scheepers, Joris J.
AU - van der Schelling, George P.
AU - Bassi, Claudio
AU - Vollmer, Charles M.
AU - Steyerberg, Ewout W.
AU - Abu Hilal, Mohammed
AU - Groot Koerkamp, Bas
AU - Besselink, Marc G.
PY - 2019/5/1
Y1 - 2019/5/1
N2 - OBJECTIVE: The aim of this study was to develop an alternative fistula risk score (a-FRS) for postoperative pancreatic fistula (POPF) after pancreatoduodenectomy, without blood loss as a predictor. BACKGROUND: Blood loss, one of the predictors of the original-FRS, was not a significant factor during 2 recent external validations. METHODS: The a-FRS was developed in 2 databases: the Dutch Pancreatic Cancer Audit (18 centers) and the University Hospital Southampton NHS. Primary outcome was grade B/C POPF according to the 2005 International Study Group on Pancreatic Surgery (ISGPS) definition. The score was externally validated in 2 independent databases (University Hospital of Verona and University Hospital of Pennsylvania), using both 2005 and 2016 ISGPS definitions. The a-FRS was also compared with the original-FRS. RESULTS: For model design, 1924 patients were included of whom 12% developed POPF. Three predictors were strongly associated with POPF: soft pancreatic texture [odds ratio (OR) 2.58, 95% confidence interval (95% CI) 1.80-3.69], small pancreatic duct diameter (per mm increase, OR: 0.68, 95% CI: 0.61-0.76), and high body mass index (BMI) (per kg/m increase, OR: 1.07, 95% CI: 1.04-1.11). Discrimination was adequate with an area under curve (AUC) of 0.75 (95% CI: 0.71-0.78) after internal validation, and 0.78 (0.74-0.82) after external validation. The predictive capacity of a-FRS was comparable with the original-FRS, both for the 2005 definition (AUC 0.78 vs 0.75, P = 0.03), and 2016 definition (AUC 0.72 vs 0.70, P = 0.05). CONCLUSION: The a-FRS predicts POPF after pancreatoduodenectomy based on 3 easily available variables (pancreatic texture, duct diameter, BMI) without blood loss and pathology, and was successfully validated for both the 2005 and 2016 POPF definition. The online calculator is available at www.pancreascalculator.com.
AB - OBJECTIVE: The aim of this study was to develop an alternative fistula risk score (a-FRS) for postoperative pancreatic fistula (POPF) after pancreatoduodenectomy, without blood loss as a predictor. BACKGROUND: Blood loss, one of the predictors of the original-FRS, was not a significant factor during 2 recent external validations. METHODS: The a-FRS was developed in 2 databases: the Dutch Pancreatic Cancer Audit (18 centers) and the University Hospital Southampton NHS. Primary outcome was grade B/C POPF according to the 2005 International Study Group on Pancreatic Surgery (ISGPS) definition. The score was externally validated in 2 independent databases (University Hospital of Verona and University Hospital of Pennsylvania), using both 2005 and 2016 ISGPS definitions. The a-FRS was also compared with the original-FRS. RESULTS: For model design, 1924 patients were included of whom 12% developed POPF. Three predictors were strongly associated with POPF: soft pancreatic texture [odds ratio (OR) 2.58, 95% confidence interval (95% CI) 1.80-3.69], small pancreatic duct diameter (per mm increase, OR: 0.68, 95% CI: 0.61-0.76), and high body mass index (BMI) (per kg/m increase, OR: 1.07, 95% CI: 1.04-1.11). Discrimination was adequate with an area under curve (AUC) of 0.75 (95% CI: 0.71-0.78) after internal validation, and 0.78 (0.74-0.82) after external validation. The predictive capacity of a-FRS was comparable with the original-FRS, both for the 2005 definition (AUC 0.78 vs 0.75, P = 0.03), and 2016 definition (AUC 0.72 vs 0.70, P = 0.05). CONCLUSION: The a-FRS predicts POPF after pancreatoduodenectomy based on 3 easily available variables (pancreatic texture, duct diameter, BMI) without blood loss and pathology, and was successfully validated for both the 2005 and 2016 POPF definition. The online calculator is available at www.pancreascalculator.com.
KW - Journal Article
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85064852937&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/29240007
U2 - https://doi.org/10.1097/SLA.0000000000002620
DO - https://doi.org/10.1097/SLA.0000000000002620
M3 - Article
C2 - 29240007
SN - 0003-4932
VL - 269
SP - 937
EP - 943
JO - Annals of surgery
JF - Annals of surgery
IS - 5
ER -