Pancreatic fistula prediction scale for laparoscopic pancreatoduodenectomy
EAES Academy. Mikhnevich M. 07/05/22; 363064; P109
CLICK HERE TO LOGIN
REGULAR CONTENT
REGULAR CONTENT
Login now to access Regular content available to all registered users.
Abstract
Discussion Forum (0)
Rate & Comment (0)
Aims:
Despite advancements in surgical technic and improvements in perioperative management, postoperative clinically relevant pancreatic fistula (POPF) remains the most life-threatening complication after laparoscopic pancreatoduodenectomy (LPD). Attempts for reinforcement of high-risk pancreatic anastomoses didn’t show statistically significant decrease in POPF rate. Therefore POPF-prediction become the most promising method for POPF-prevention. Prediction results were compared to updated alternative fistula risk score (UA-FRS) prognosis.
Methods:
We established post pancreatoduodenectomy fistula risk scale (PP-FRS) derived from a retrospective cohort (n=78). Pancreatic density for the supposed resection line was estimated using preoperative CT (CT-density during delay phase, CT-attenuation coefficient) and intraoperative palpation scoring (0-4, where 4 score corresponds the firmest parenchyma). These risk factors afforded 6-points prediction model, where 5 and 6 points corresponds a high-risk patient. PP-FRS was validated retrospectively. ROC-AUC and Kendall rank correlation coefficient were compared with UA-FRS prediction results for the same cohort.
Results:
CR-POPF occurs in 25% cases (9% - Grade B, 16% - Grade C). ROC-AUC for PP-FRS and UA-FRS was 0.793 and 0.891, respectively. Risk scores strongly correlated with fistula development (p<0.01). Kendall coefficient was 0.429 and 0.498 for PP-FRS and UA-FRS, respectively.
Conclusions:
A simple 6-points PP-FRS accurately predicts the risk of CR-POPF after LPD. This can be helpful during preoperative counseling, regarding the amount of planned surgical treatment (pancreatic resection or pancreatectomy); intraoperative mitigation strategy (external pancreatic stenting, refusing somatostatin analogues). While planning a clinical trial PP-FRS can distinguish high-risk patients to form homogeneous comparing groups.
Despite advancements in surgical technic and improvements in perioperative management, postoperative clinically relevant pancreatic fistula (POPF) remains the most life-threatening complication after laparoscopic pancreatoduodenectomy (LPD). Attempts for reinforcement of high-risk pancreatic anastomoses didn’t show statistically significant decrease in POPF rate. Therefore POPF-prediction become the most promising method for POPF-prevention. Prediction results were compared to updated alternative fistula risk score (UA-FRS) prognosis.
Methods:
We established post pancreatoduodenectomy fistula risk scale (PP-FRS) derived from a retrospective cohort (n=78). Pancreatic density for the supposed resection line was estimated using preoperative CT (CT-density during delay phase, CT-attenuation coefficient) and intraoperative palpation scoring (0-4, where 4 score corresponds the firmest parenchyma). These risk factors afforded 6-points prediction model, where 5 and 6 points corresponds a high-risk patient. PP-FRS was validated retrospectively. ROC-AUC and Kendall rank correlation coefficient were compared with UA-FRS prediction results for the same cohort.
Results:
CR-POPF occurs in 25% cases (9% - Grade B, 16% - Grade C). ROC-AUC for PP-FRS and UA-FRS was 0.793 and 0.891, respectively. Risk scores strongly correlated with fistula development (p<0.01). Kendall coefficient was 0.429 and 0.498 for PP-FRS and UA-FRS, respectively.
Conclusions:
A simple 6-points PP-FRS accurately predicts the risk of CR-POPF after LPD. This can be helpful during preoperative counseling, regarding the amount of planned surgical treatment (pancreatic resection or pancreatectomy); intraoperative mitigation strategy (external pancreatic stenting, refusing somatostatin analogues). While planning a clinical trial PP-FRS can distinguish high-risk patients to form homogeneous comparing groups.
Aims:
Despite advancements in surgical technic and improvements in perioperative management, postoperative clinically relevant pancreatic fistula (POPF) remains the most life-threatening complication after laparoscopic pancreatoduodenectomy (LPD). Attempts for reinforcement of high-risk pancreatic anastomoses didn’t show statistically significant decrease in POPF rate. Therefore POPF-prediction become the most promising method for POPF-prevention. Prediction results were compared to updated alternative fistula risk score (UA-FRS) prognosis.
Methods:
We established post pancreatoduodenectomy fistula risk scale (PP-FRS) derived from a retrospective cohort (n=78). Pancreatic density for the supposed resection line was estimated using preoperative CT (CT-density during delay phase, CT-attenuation coefficient) and intraoperative palpation scoring (0-4, where 4 score corresponds the firmest parenchyma). These risk factors afforded 6-points prediction model, where 5 and 6 points corresponds a high-risk patient. PP-FRS was validated retrospectively. ROC-AUC and Kendall rank correlation coefficient were compared with UA-FRS prediction results for the same cohort.
Results:
CR-POPF occurs in 25% cases (9% - Grade B, 16% - Grade C). ROC-AUC for PP-FRS and UA-FRS was 0.793 and 0.891, respectively. Risk scores strongly correlated with fistula development (p<0.01). Kendall coefficient was 0.429 and 0.498 for PP-FRS and UA-FRS, respectively.
Conclusions:
A simple 6-points PP-FRS accurately predicts the risk of CR-POPF after LPD. This can be helpful during preoperative counseling, regarding the amount of planned surgical treatment (pancreatic resection or pancreatectomy); intraoperative mitigation strategy (external pancreatic stenting, refusing somatostatin analogues). While planning a clinical trial PP-FRS can distinguish high-risk patients to form homogeneous comparing groups.
Despite advancements in surgical technic and improvements in perioperative management, postoperative clinically relevant pancreatic fistula (POPF) remains the most life-threatening complication after laparoscopic pancreatoduodenectomy (LPD). Attempts for reinforcement of high-risk pancreatic anastomoses didn’t show statistically significant decrease in POPF rate. Therefore POPF-prediction become the most promising method for POPF-prevention. Prediction results were compared to updated alternative fistula risk score (UA-FRS) prognosis.
Methods:
We established post pancreatoduodenectomy fistula risk scale (PP-FRS) derived from a retrospective cohort (n=78). Pancreatic density for the supposed resection line was estimated using preoperative CT (CT-density during delay phase, CT-attenuation coefficient) and intraoperative palpation scoring (0-4, where 4 score corresponds the firmest parenchyma). These risk factors afforded 6-points prediction model, where 5 and 6 points corresponds a high-risk patient. PP-FRS was validated retrospectively. ROC-AUC and Kendall rank correlation coefficient were compared with UA-FRS prediction results for the same cohort.
Results:
CR-POPF occurs in 25% cases (9% - Grade B, 16% - Grade C). ROC-AUC for PP-FRS and UA-FRS was 0.793 and 0.891, respectively. Risk scores strongly correlated with fistula development (p<0.01). Kendall coefficient was 0.429 and 0.498 for PP-FRS and UA-FRS, respectively.
Conclusions:
A simple 6-points PP-FRS accurately predicts the risk of CR-POPF after LPD. This can be helpful during preoperative counseling, regarding the amount of planned surgical treatment (pancreatic resection or pancreatectomy); intraoperative mitigation strategy (external pancreatic stenting, refusing somatostatin analogues). While planning a clinical trial PP-FRS can distinguish high-risk patients to form homogeneous comparing groups.
Code of conduct/disclaimer available in General Terms & Conditions
{{ help_message }}
{{filter}}