Prediction of postoperative pancreatic fistula using a nomogram based on the updated definition
Cheng-Xiang Guo1,2, Yi-Nan Shen1,2, Qi Zhang1,2
1Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Insights
A new nomogram accurately predicts postoperative pancreatic fistula (POPF) risk after pancreaticoduodenectomy (PD). This tool identifies key risk factors, aiding personalized patient management and improving surgical outcomes.
Area of Science:
- Surgical Oncology
- Gastroenterology
- Medical Informatics
Background:
- Postoperative pancreatic fistula (POPF) is a significant complication following pancreaticoduodenectomy (PD).
- The International Study Group on Pancreatic Fistula recently updated its definition of POPF.
- Accurate prediction of POPF is crucial for patient management and risk stratification.
Purpose of the Study:
- To identify independent risk factors for POPF in patients undergoing PD.
- To develop and validate a predictive nomogram for POPF after PD.
- To compare the performance of the new nomogram against existing models.
Main Methods:
- Retrospective review of data from 298 patients who underwent PD.
- Redefinition of POPF statuses based on the updated criteria.
- Construction and internal validation of a nomogram using 220 patients, with external validation on 78 patients.
- Univariate and multivariate analyses to identify independent risk factors.
Main Results:
- Identified risk factors include pancreatic texture, main pancreatic duct size, portal vein invasion, and definitive pathology.
- The developed nomogram demonstrated strong predictive accuracy (C-index 0.793 internally, 0.816 in validation cohort).
- The nomogram outperformed existing models and stratifies patients into low, intermediate, and high-risk groups.
Conclusions:
- The developed nomogram accurately predicts POPF in patients undergoing PD.
- This tool facilitates personalized management strategies for patients at risk of POPF.
- The nomogram offers improved predictive performance compared to established models.
Purpose:
The International Study Group on Pancreatic Fistula's definition of postoperative pancreatic fistula (POPF) has recently been updated. This study aimed to identify risk factors for POPF in patients having pancreaticoduodenectomy (PD) and to generate a nomogram to predict POPF.
Methods:
Data on 298 patients who underwent PD from March 2012 to October 2017 was retrospectively reviewed and POPF statuses were redefined. A nomogram was constructed using data from 220 patients and validated using the remaining 78 patients. Independent risk factors for POPF were identified using univariate and multivariate analyses. A predictive nomogram was established based on the independent risk factors and was compared with existing models.
Results:
Texture of the pancreas, size of the main pancreatic duct, portal vein invasion, and definitive pathology were the identified risk factors. The nomogram had a C-index of 0.793 and was internally validated. The nomogram performed better (C-index of 0.816) than the other most cited models (C-indexes of 0.728 and 0.735) in the validation cohort. In addition, the nomogram can assign patients into low- (less than 10%), intermediate- (10% to 30%), and high-risk (equal or higher than 30%) groups to facilitate personalized management.
Conclusion:
The nomogram accurately predicted POPF in patients having PD.
