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Scoring System to Predict Pancreatic Fistula After Pancreaticoduodenectomy: A UK Multicenter Study
Keith J Roberts1, Robert P Sutcliffe, Ravi Marudanayagam
1*University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom †Cambridge University Hospital NHS Foundation Trust, Cambridge, United Kingdom ‡Royal Infirmary of Edinburgh, Edinburgh, United Kingdom §Kings College Hospital, London, United Kingdom ¶Morriston Hospital Swansea, Wales, United Kingdom ‖St James' University Hospital Leeds, West Yorkshire, United Kingdom **Royal Free Hospital London, London, United Kingdom; and ††Southampton University Hospital, Hampshire, United Kingdom.
Insights
A validated preoperative score accurately predicts postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD). This score aids in personalizing patient care and research, as it could not be improved upon.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Clinical Risk Prediction
Background:
- Postoperative pancreatic fistula (POPF) is a significant cause of morbidity following pancreaticoduodenectomy (PD).
- A previously developed preoperative score utilizing body mass index (BMI) and pancreatic duct width requires validation in a larger cohort.
- Identifying reliable predictors is crucial for improving patient outcomes after PD.
Purpose of the Study:
- To validate a preoperative predictive score for POPF in a multicenter patient cohort.
- To identify additional risk factors that could enhance the predictive accuracy of the existing score.
Main Methods:
- A multicenter study involving 630 patients undergoing PD across 8 UK centers.
- Statistical analysis assessed the association between the predictive score, various clinical variables, and POPF occurrence.
- Stepwise multivariate analysis was employed to determine independent predictors of POPF.
Main Results:
- The study identified 141 cases of POPF (22.4%) among the 630 patients.
- Multiple factors including BMI, perirenal fat thickness, pancreatic duct width, bilirubin, pancreatojejunostomy technique, pathology, and gland firmness were associated with POPF.
- The preoperative score demonstrated significant predictive power for POPF (P < 0.001) and correlated with its severity, remaining the sole consistent predictor in multivariate analysis.
Conclusions:
- The validated preoperative predictive score for POPF performs well and cannot be significantly improved.
- This validated score offers valuable opportunities for personalized patient consent, selection, and treatment strategies.
- The findings support the use of this score in guiding clinical decision-making and future research in pancreatic surgery.
Objective:
To validate a preoperative predictive score of postoperative pancreatic fistula (POPF). Other risk factors for POPF were sought in an attempt to improve the score.
Background:
POPF is the major contributor to morbidity after pancreaticoduodenectomy (PD). A preoperative score [using body mass index (BMI) and pancreatic duct width] to predict POPF was tested upon a multicenter patient cohort to assess its performance.
Methods:
Patients undergoing PD at 8 UK centers were identified. The association between the score and other pre-, intra-, and postoperative variables with POPF was assessed.
Results:
A total of 630 patients underwent PD with 141 occurrences of POPF (22.4%). BMI, perirenal fat thickness, pancreatic duct width on computed tomography and at operation, bilirubin, pancreatojejunostomy technique, underlying pathology, T stage, N stage, R status, and gland firmness were all significantly associated with POPF. The score predicted POPF (P < 0.001) with a higher predictive score associated with increasing severity of POPF (P < 0.001). Stepwise multivariate analysis of pre-, intra-, and postoperative variables demonstrated that only the score was consistently associated with POPF. A table correlating the risk score to actual risk of POPF was created.
Conclusions:
The predictive score performed well and could not be improved. This provides opportunities for individualizing patient consent and selection, and treatment and research applications.
