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Distal Pancreatectomy Fistula Risk Score (D-FRS): Development and International Validation
Matteo De Pastena1,2, Eduard A van Bodegraven2, Timothy H Mungroop2
1General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy.
Annals of Surgery
|July 7, 2022
Summary
New risk scores predict postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP). These validated tools, the preoperative and intraoperative D-FRS, aid in personalized prevention and mitigation strategies for patients undergoing DP.
Area of Science:
- Surgical Oncology
- Gastroenterology
- Medical Informatics
Background:
- Postoperative pancreatic fistula (POPF) is the most frequent complication following distal pancreatectomy (DP).
- Existing risk factors for POPF lack a comprehensive predictive model.
- Developing accurate risk stratification is crucial for improving patient outcomes after DP.
Purpose of the Study:
- To develop and validate two distinct risk scores: one for preoperative prediction and one for intraoperative assessment of POPF risk after DP.
- To enhance preventive strategies using a preoperative score and mitigation strategies using an intraoperative score.
- To provide clinicians with validated tools for personalized patient management and benchmarking.
Main Methods:
- Multivariable logistic regression was used to develop risk scores from a cohort of 1336 patients undergoing DP across Italian, US, and Dutch centers (2007-2016).
- Internal validation was performed using bootstrapping, followed by internal-external validation on pooled data.
- The preoperative distal fistula risk score (D-FRS) incorporated pancreatic neck thickness and duct diameter; the intraoperative D-FRS additionally included BMI, pancreatic texture, and operative time.
Main Results:
- The preoperative D-FRS demonstrated strong predictive performance (AUC 0.83 internal-external validation) and identified three risk groups: low (<10%), intermediate (10-25%), and high (>25%) POPF risk.
- The intraoperative D-FRS also showed good predictive ability (AUC 0.80) by incorporating additional intraoperative variables.
- A total of 291 (22%) patients developed POPF, with the scores effectively stratifying risk across the patient cohort.
Conclusions:
- The preoperative and intraoperative D-FRS are the first validated risk scores for predicting POPF after DP.
- These scores are accessible online, facilitating their integration into clinical practice.
- The identified risk groups enable personalized treatment approaches and performance benchmarking for DP procedures.
