Updated Alternative Fistula Risk Score (ua-FRS) to Include Minimally Invasive Pancreatoduodenectomy: Pan-European Validation.

Autor:	Mungroop TH; Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, The Netherlands., Klompmaker S; Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, The Netherlands., Wellner UF; Clinic of Surgery, UKSH Campus Lübeck, Lübeck, Germany.; Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV) Studien-, Dokumentations- und Qualitätszentrum (StuDoQ|Pancreas), Germany., Steyerberg EW; Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands., Coratti A; Department of Oncology and Robotic Surgery, Careggi University Hospital, Florence, Italy., D'Hondt M; Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium., de Pastena M; Department of Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy., Dokmak S; Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France., Khatkov I; Department of Surgery, Moscow Clinical Scientific Center, Moscow, Russia., Saint-Marc O; Department of Surgery, Centre Hospitalier Régional Orleans, Orleans, France., Wittel U; Department of Visceral and General Surgery, University of Freiburg Medical Center, Freiburg, Germany., Abu Hilal M; Department of Surgery, Southampton University Hospital NHS Foundation Trust, Southampton, United Kingdom., Fuks D; Department of Digestive, Oncological and Metabolic Surgery, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France., Poves I; Department of Surgery, Hospital del Mar, Barcelona, Spain., Keck T; Clinic of Surgery, UKSH Campus Lübeck, Lübeck, Germany.; Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV) Studien-, Dokumentations- und Qualitätszentrum (StuDoQ|Pancreas), Germany., Boggi U; Division of General and Transplant Surgery, University of Pisa, Pisa, Italy., Besselink MG; Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, The Netherlands.
Jazyk:	angličtina
Zdroj:	Annals of surgery [Ann Surg] 2021 Feb 01; Vol. 273 (2), pp. 334-340.
DOI:	10.1097/SLA.0000000000003234
Abstrakt:	Objective: The aim of the study was to validate and optimize the alternative Fistula Risk Score (a-FRS) for patients undergoing minimally invasive pancreatoduodenectomy (MIPD) in a large pan-European cohort. Background: MIPD may be associated with an increased risk of postoperative pancreatic fistula (POPF). The a-FRS could allow for risk-adjusted comparisons in research and improve preventive strategies for high-risk patients. The a-FRS, however, has not yet been validated specifically for laparoscopic, robot-assisted, and hybrid MIPD. Methods: A validation study was performed in a pan-European cohort of 952 consecutive patients undergoing MIPD (543 laparoscopic, 258 robot-assisted, 151 hybrid) in 26 centers from 7 countries between 2007 and 2017. The primary outcome was POPF (International Study Group on Pancreatic Surgery grade B/C). Model performance was assessed using the area under the receiver operating curve (AUC; discrimination) and calibration plots. Validation included univariable screening for clinical variables that could improve performance. Results: Overall, 202 of 952 patients (21%) developed POPF after MIPD. Before adjustment, the original a-FRS performed moderately (AUC 0.68) and calibration was inadequate with systematic underestimation of the POPF risk. Single-row pancreatojejunostomy (odds ratio 4.6, 95 confidence interval [CI] 2.8-7.6) and male sex (odds ratio 1.9, 95 CI 1.4-2.7) were identified as important risk factors for POPF in MIPD. The updated a-FRS, consisting of body mass index, pancreatic texture, duct size, and male sex, showed good discrimination (AUC 0.75, 95 CI 0.71-0.79) and adequate calibration. Performance was adequate for laparoscopic, robot-assisted, and hybrid MIPD and open pancreatoduodenectomy. Conclusions: The updated a-FRS (www.pancreascalculator.com) now includes male sex as a risk factor and is validated for both MIPD and open pancreatoduodenectomy. The increased risk of POPF in laparoscopic MIPD was associated with single-row pancreatojejunostomy, which should therefore be discouraged. Competing Interests: The authors report no conflicts of interests. (Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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