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Updated: Jun 16, 2025
Technical Detail for Robot Assisted Pancreaticoduodenectomy
Published on: September 28, 2019
Validation and modification of the PAncreatic surgery Composite Endpoint (PACE) model: A single-institution study
Hwee Leong Tan1, Yun Zhao2, Darren Weiquan Chua3
1Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital and National Cancer Centre Singapore, Academia, Singapore; Duke-National University of Singapore Medical School, Singapore.
Background:
The PAncreatic surgery Composite Endpoint was developed as a standardized, clinically relevant outcome measure for pancreatectomies, and it has been shown to correlate with prolonged length of stay and 90-day mortality. Although the PAncreatic surgery Composite Endpoint combines key complications of postoperative pancreatic fistula, postpancreatectomy hemorrhage, and reoperation/reintervention into a single measure, delayed gastric emptying has not been integrated. We aimed to validate PAncreatic surgery Composite Endpoint and assess whether adding delayed gastric emptying (modified PAncreatic surgery Composite Endpoint) enhances its predictive performance in a Southeast Asian cohort.
Methods:
Prolonged length of stay was defined as ≥20 days (the 75th percentile of length of stay). PAncreatic surgery Composite Endpoint and modified PAncreatic surgery Composite Endpoint were evaluated as binary indicators using logistic regression analyses to assess their associations with prolonged length of stay and 90-day mortality. Model performance was evaluated using the area under the receiver operating characteristic curve, sensitivity, specificity, and calibration curves.
Results:
A total of 575 patients underwent pancreatectomy at Singapore General Hospital between 2018 and 2023. When predicting prolonged length of stay, modified PAncreatic surgery Composite Endpoint (area under the receiver operating characteristic curve, 0.781; sensitivity, 79.2%; specificity, 77.0%) outperformed PAncreatic surgery Composite Endpoint (area under the receiver operating characteristic curve, 0.669; sensitivity, 53.0%; specificity, 80.8%), demonstrating stronger discrimination in both pancreatoduodenectomy and distal pancreatectomy subcohorts and retaining good calibration. For postoperative 90-day mortality, PAncreatic surgery Composite Endpoint and modified PAncreatic surgery Composite Endpoint demonstrated moderate, comparable performance (area under the receiver operating characteristic curves of 0.682 and 0.679, respectively) and exhibited good calibration.
Conclusion:
The PAncreatic surgery Composite Endpoint and modified PAncreatic surgery Composite Endpoint models are robust and clinically relevant tools for predicting prolonged length of stay and 90-day mortality after pancreatectomy. Adding delayed gastric emptying to the modified PAncreatic surgery Composite Endpoint model enhances its predictive performance for prolonged length of stay.
