External validation of alternative fistula risk score (a-FRS) for predicting pancreatic fistula after pancreatoduodenectomy

Mengyi Lao; Xiaozhen Zhang; Chenxiang Guo; Wei Chen; Qi Zhang; Tao Ma; Xueli Bai; Tingbo Liang

doi:10.1016/j.hpb.2019.05.007

External validation of alternative fistula risk score (a-FRS) for predicting pancreatic fistula after pancreatoduodenectomy

HPB (Oxford). 2020 Jan;22(1):58-66. doi: 10.1016/j.hpb.2019.05.007. Epub 2019 Jul 2.

Authors

Mengyi Lao¹, Xiaozhen Zhang¹, Chenxiang Guo¹, Wei Chen¹, Qi Zhang¹, Tao Ma², Xueli Bai³, Tingbo Liang⁴

Affiliations

¹ Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou, China.
² Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou, China. Electronic address: zjuamtao@zju.edu.cn.
³ Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou, China. Electronic address: shirlerybai@zju.edu.cn.
⁴ Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang Provincial Key Laboratory of Pancreatic Disease, Hangzhou, China. Electronic address: liangtingbo@zju.edu.cn.

PMID: 31272847
DOI: 10.1016/j.hpb.2019.05.007

Abstract

Background: The utility of the proposed alternative fistula risk score (a-FRS) for predicting risk of clinically relevant postoperative pancreatic fistula (CR-POPF) after pancreaticoduodenectomy (PD) has not been validated widely.

Methods: This retrospective analysis included data of patients undergoing open and laparoscopic PD during March 2012-May 2018 in our institution. The predictive abilities of a-FRS and original-FRS were compared. Risk factors for CR-POPF were also evaluated by multivariate regression analysis.

Results: Of the 370 patients, 80 (21.62%) developed CR-POPF. The incidences of CR-POPF in patients classified as low risk, intermediate risk, and high risk by a-FRS were 5.88%, 24.38%, and 57.69%, respectively (R2 = 0.97). The incidences of CR-POPF in patients classified as negligible risk, low risk, intermediate risk, and high-risk by original-FRS were 0%, 8.62%, 21.51%, and 52.50%, respectively (R2 = 0.92). The area under the ROC curve (AUC) was 0.74 for a-FRS vs. 0.70 for original-FRS. The a-FRS performed better than original-FRS for prediction of CR-POPF in open PD patients (AUC: 0.74 vs. 0.69) and was comparable with original- FRS in laparoscopic PD patients (AUC: 0.70 vs. 0.72).

Conclusions: The a-FRS appears to be an accurate and convenient tool for predicting occurrence of CR-POPF after PD.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Feasibility Studies
Female
Humans
Incidence
Laparoscopy / adverse effects
Male
Middle Aged
Pancreatic Fistula / diagnosis
Pancreatic Fistula / epidemiology*
Pancreatic Neoplasms / complications
Pancreatic Neoplasms / pathology
Pancreatic Neoplasms / surgery*
Pancreaticoduodenectomy / adverse effects*
Postoperative Complications / diagnosis
Postoperative Complications / epidemiology*
Predictive Value of Tests
ROC Curve
Regression Analysis
Retrospective Studies
Risk Assessment
Risk Factors