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van Bodegraven EA, den Haring FET, Pollemans B, Monselis D, De Pastena M, van Eijck C, Daams F, de Hingh I, Luyer M, Stommel MWJ, van Santvoort HC, Festen S, Mieog JSD, Klaase J, Lips D, Coolsen MME, van der Schelling GP, Manusama ER, Patijn G, van der Harst E, Bosscha K, Marchegiani G, Besselink MG. Nationwide validation of the distal fistula risk score (D-FRS). Langenbecks Arch Surg 2023; 409:14. [PMID: 38114826 DOI: 10.1007/s00423-023-03192-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 11/24/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE Distal pancreatectomy (DP) is associated with a high complication rate of 30-50% with postoperative pancreatic fistula (POPF) as a dominant contributor. Adequate risk estimation for POPF enables surgeons to use a tailor-made approach. Assessment of the risk of POPF prior to DP can lead to the application of preventive strategies. The current study aims to validate the recently published preoperative and intraoperative distal fistula risk score (D-FRS) in a nationwide cohort. METHODS This nationwide retrospective Dutch cohort study included all patients after DP for any indication, all of whom were registered in the Dutch Pancreatic Cancer Audit (DPCA) database between 2013 and 2021. The D-FRS was validated by filling in the probability equations with data from this cohort. The predictive capacity of the models was represented by an area under the receiver operating characteristic (AUROC) curve. RESULTS A total of 896 patients underwent DP of which 152 (17%) developed POPF of whom 144 grade B (95%) and 8 grade C (5%). The preoperative D-FRS, consisting of the variables pancreatic neck thickness and pancreatic duct diameter, showed an AUROC of 0.73 (95%CI 0.68-0.78). The intraoperative D-FRS, comprising pancreatic neck, duct diameter, BMI, operating time, and soft pancreatic aspect, showed an AUROC of 0.69 (95%CI 0.64-0.74). CONCLUSION The current study is the first nationwide validation of the preoperative and intraoperative D-FRS showing acceptable distinguishing capacity for only the preoperative D-FRS for POPF. Therefore, the preoperative score could improve prevention and mitigation strategies such as drain management, which is currently investigated in the multicenter PANDORINA trial.
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Affiliation(s)
- Eduard A van Bodegraven
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, De Boelelaan 1117 (ZH-7F), 1081, HV, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Femke E T den Haring
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, De Boelelaan 1117 (ZH-7F), 1081, HV, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Britt Pollemans
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, De Boelelaan 1117 (ZH-7F), 1081, HV, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Damaris Monselis
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, De Boelelaan 1117 (ZH-7F), 1081, HV, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Matteo De Pastena
- General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
| | - Casper van Eijck
- Department of Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Freek Daams
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, De Boelelaan 1117 (ZH-7F), 1081, HV, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Ignace de Hingh
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Misha Luyer
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - Martijn W J Stommel
- Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Hjalmar C van Santvoort
- Department of Surgery, Regional Academic Cancer Center Utrecht (RAKU), Utrecht, the Netherlands
| | - S Festen
- Department of Surgery, OLVG, Amsterdam, the Netherlands
| | - J S D Mieog
- Department of Surgery, LUMC, Leiden, the Netherlands
| | - J Klaase
- Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - D Lips
- Department of Surgery, Medisch Spectrum Twente, Enschede, the Netherlands
| | - M M E Coolsen
- Department of Surgery, Maastricht Universitair Medisch Centrum, Maastricht, the Netherlands
| | - G P van der Schelling
- Department of Gastroenterology and Hepatology, Amphia Hospital, Breda, the Netherlands
| | - E R Manusama
- Department of Surgery, Medical Center Leeuwarden, Leeuwarden, the Netherlands
| | - G Patijn
- Department of Surgery, Isala Clinics, Zwolle, the Netherlands
| | - E van der Harst
- Department of Surgery, Maasstad Hospital, Rotterdam, the Netherlands
| | - K Bosscha
- Department of Surgery, Jeroen Bosch Hospital, Den Bosch, the Netherlands
| | - Giovanni Marchegiani
- General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy
| | - Marc G Besselink
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, De Boelelaan 1117 (ZH-7F), 1081, HV, Amsterdam, the Netherlands.
- Cancer Center Amsterdam, Amsterdam, the Netherlands.
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