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Alternative Fistula Risk Score for Pancreatoduodenectomy (a-FRS): Design and International External Validation
Timothy H Mungroop1, L Bengt van Rijssen1, David van Klaveren2
1Department of Surgery, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, the Netherlands.
Annals of Surgery
|December 15, 2017
Summary
A new alternative fistula risk score (a-FRS) predicts postoperative pancreatic fistula (POPF) after pancreatoduodenectomy using pancreatic texture, duct diameter, and BMI. This score offers a reliable alternative to existing methods, validated across multiple definitions.
Area of Science:
- Surgical Oncology
- Gastroenterology
- Medical Informatics
Background:
- The original fistula risk score (FRS) for postoperative pancreatic fistula (POPF) includes blood loss as a predictor.
- Recent external validations indicate blood loss is not a significant factor in POPF prediction.
- There is a need for an updated risk score that excludes less significant predictors.
Purpose of the Study:
- To develop and validate an alternative fistula risk score (a-FRS) for predicting POPF after pancreatoduodenectomy.
- To exclude blood loss and pathology as predictors in the new risk score.
- To compare the performance of the a-FRS with the original FRS.
Main Methods:
- The a-FRS was developed using data from the Dutch Pancreatic Cancer Audit and University Hospital Southampton NHS (18 centers).
- Grade B/C POPF, defined by the 2005 International Study Group on Pancreatic Surgery (ISGPS) criteria, was the primary outcome.
- External validation was performed in independent databases (University Hospital of Verona and University Hospital of Pennsylvania) using both 2005 and 2016 ISGPS definitions.
Main Results:
- The final model included 1924 patients, with a POPF incidence of 12%.
- Key predictors identified for POPF were soft pancreatic texture (OR 2.58), small pancreatic duct diameter (OR 0.68 per mm increase), and high body mass index (BMI) (OR 1.07 per kg/m increase).
- The a-FRS demonstrated adequate discrimination with an area under the curve (AUC) of 0.75 (internal validation) and 0.78 (external validation), comparable to the original FRS for both 2005 and 2016 definitions.
Conclusions:
- The a-FRS effectively predicts POPF after pancreatoduodenectomy using three readily available variables: pancreatic texture, duct diameter, and BMI.
- The score was successfully validated for both the 2005 and 2016 POPF definitions.
- An online calculator for the a-FRS is available at www.pancreascalculator.com.
