Abstract：
BACKGROUND: The incidence of clinically relevant postoperative pancreatic fistula (CR-POPF) after central pancreatectomy (CP) is high, yet an effective predictive method is currently lacking. This study aimed to predict CR-POPF after CP by utilizing existing fistula risk scores (FRSs) for pancreaticoduodenectomy (PD) and distal pancreatectomy (DP).
METHODS: A retrospective analysis was conducted on patients undergoing CP at our institution between January 2010 and July 2022. The primary outcome was CR-POPF (grade B/C) according to the 2016 International Study Group of Pancreatic Surgery definition. To establish predictive models for CR-POPF after CP, we combined the FRSs for PD and DP using a calculation formula that considers the probability of the union of two events. As a result, we obtained twelve central FRS (C-FRS) models. The performance of each C-FRS was assessed using the area under the curves (AUC) and calibration plots.
RESULTS: A total of 115 patients undergoing CP were included. Among them, 38 (33%) were male, with a median age of 53 years. CR-POPF occurred in 35 (30.4%) patients, specifically 33 (28.7%) with grade B and 2 (1.7%) with grade C. Multivariate analysis showed that body mass index (BMI) [odds ratio (OR) 1.260, 95% confidence interval (CI) 1.039-1.528, P = 0.019), pancreatic thickness at the cephalic transection site (OR 1.228, 95% CI 1.074-1.405, P = 0.003), cephalic main pancreatic duct (MPD) size (OR 41.872, 95%CI 7.614-230.265, P < 0.001), and distal MPD size (OR 0.142, 95% CI 0.036-0.561, P = 0.005) were independent predictive factors for CR-POPF. Discrimination was generally acceptable for all C-FRS models, with an AUC ranging from 0.748 (DISPAIR-a-FRS: 95% CI, 0.659-0.824) to 0.847 (Intraop-D-a-FRS: 95% CI, 0.768-0.907). The models were calibrated with adequate Brier scores ranging from 0.157 to 0.183. The performance in all subgroups was similar as that of the entire cohort. Three preoperative risk groups (low, intermediate, and high) were identified based on the clinical applicability of the Preop-D-Roberts-FRS, with corresponding incidences of CR-POPF as 0% (0/24), 30% (21/70), and 66.7% (14/21), respectively.
CONCLUSIONS: The derived C-FRS models show potential for accurately predicting the development of CR-POPF after CP. However, further validation studies are required to determine the most effective model. In the meantime, the Preop-D-Roberts-FRS is recommended for clinical practice due to its ease of use and preoperative predictability.
METHODS: A retrospective analysis was conducted on patients undergoing CP at our institution between January 2010 and July 2022. The primary outcome was CR-POPF (grade B/C) according to the 2016 International Study Group of Pancreatic Surgery definition. To establish predictive models for CR-POPF after CP, we combined the FRSs for PD and DP using a calculation formula that considers the probability of the union of two events. As a result, we obtained twelve central FRS (C-FRS) models. The performance of each C-FRS was assessed using the area under the curves (AUC) and calibration plots.
RESULTS: A total of 115 patients undergoing CP were included. Among them, 38 (33%) were male, with a median age of 53 years. CR-POPF occurred in 35 (30.4%) patients, specifically 33 (28.7%) with grade B and 2 (1.7%) with grade C. Multivariate analysis showed that body mass index (BMI) [odds ratio (OR) 1.260, 95% confidence interval (CI) 1.039-1.528, P = 0.019), pancreatic thickness at the cephalic transection site (OR 1.228, 95% CI 1.074-1.405, P = 0.003), cephalic main pancreatic duct (MPD) size (OR 41.872, 95%CI 7.614-230.265, P < 0.001), and distal MPD size (OR 0.142, 95% CI 0.036-0.561, P = 0.005) were independent predictive factors for CR-POPF. Discrimination was generally acceptable for all C-FRS models, with an AUC ranging from 0.748 (DISPAIR-a-FRS: 95% CI, 0.659-0.824) to 0.847 (Intraop-D-a-FRS: 95% CI, 0.768-0.907). The models were calibrated with adequate Brier scores ranging from 0.157 to 0.183. The performance in all subgroups was similar as that of the entire cohort. Three preoperative risk groups (low, intermediate, and high) were identified based on the clinical applicability of the Preop-D-Roberts-FRS, with corresponding incidences of CR-POPF as 0% (0/24), 30% (21/70), and 66.7% (14/21), respectively.
CONCLUSIONS: The derived C-FRS models show potential for accurately predicting the development of CR-POPF after CP. However, further validation studies are required to determine the most effective model. In the meantime, the Preop-D-Roberts-FRS is recommended for clinical practice due to its ease of use and preoperative predictability.
摘要：
背景：胰腺中央切除术（CP）后临床相关的术后胰瘘（CR-POPF）的发生率很高，然而，目前缺乏有效的预测方法。这项研究旨在通过利用现有的胰十二指肠切除术（PD）和远端胰腺切除术（DP）的瘘风险评分（FRS）来预测CP后的CR-POPF。
方法：对2010年1月至2022年7月在我们机构接受CP的患者进行了回顾性分析。根据2016年国际胰腺手术研究小组的定义，主要结果是CR-POPF（B/C级）。建立CP后CR-POPF的预测模型，我们使用考虑两个事件并集概率的计算公式将PD和DP的FRS合并。因此,我们获得了12个中央FRS（C-FRS）模型。使用曲线下面积(AUC)和校准图评估每个C-FRS的性能。
结果：共纳入115例接受CP的患者。其中,38（33%）为男性，平均年龄为53岁。35例(30.4%)患者发生CR-POPF,具体为B级33（28.7％）和C级2（1.7％）。多变量分析表明，体重指数（BMI）[比值比（OR）1.260，95％置信区间（CI）1.039-1.528，P=0.019），头部横切部位的胰腺厚度（OR1.228，95％CI1.074-1.405，P=0.003），头主胰管（MPD）大小（OR41.872，95CI7.614-230.265，P<0.001），远端MPD大小（OR0.142，95％CI0.036-0.561，P=0.005）是CR-POPF的独立预测因素。所有C-FRS模型的歧视通常都是可以接受的，AUC范围为0.748（DISPAIR-a-FRS：95%CI，0.659-0.824）至0.847（Intraop-D-a-FRS：95%CI，0.768-0.907）。用范围为0.157至0.183的适当Brier分数对模型进行校准。所有亚组的表现与整个队列相似。三个术前风险组（低，中间,和高)是根据Preop-D-Roberts-FRS的临床适用性确定的，CR-POPF的相应发生率为0%(0/24)，30%（21/70），和66.7%(14/21)，分别。
结论：推导的C-FRS模型显示出准确预测CP后CR-POPF发展的潜力。然而,需要进一步的验证研究来确定最有效的模型.同时,Preop-D-Roberts-FRS由于其易于使用和术前可预测性,因此推荐用于临床实践.
方法：对2010年1月至2022年7月在我们机构接受CP的患者进行了回顾性分析。根据2016年国际胰腺手术研究小组的定义，主要结果是CR-POPF（B/C级）。建立CP后CR-POPF的预测模型，我们使用考虑两个事件并集概率的计算公式将PD和DP的FRS合并。因此,我们获得了12个中央FRS（C-FRS）模型。使用曲线下面积(AUC)和校准图评估每个C-FRS的性能。
结果：共纳入115例接受CP的患者。其中,38（33%）为男性，平均年龄为53岁。35例(30.4%)患者发生CR-POPF,具体为B级33（28.7％）和C级2（1.7％）。多变量分析表明，体重指数（BMI）[比值比（OR）1.260，95％置信区间（CI）1.039-1.528，P=0.019），头部横切部位的胰腺厚度（OR1.228，95％CI1.074-1.405，P=0.003），头主胰管（MPD）大小（OR41.872，95CI7.614-230.265，P<0.001），远端MPD大小（OR0.142，95％CI0.036-0.561，P=0.005）是CR-POPF的独立预测因素。所有C-FRS模型的歧视通常都是可以接受的，AUC范围为0.748（DISPAIR-a-FRS：95%CI，0.659-0.824）至0.847（Intraop-D-a-FRS：95%CI，0.768-0.907）。用范围为0.157至0.183的适当Brier分数对模型进行校准。所有亚组的表现与整个队列相似。三个术前风险组（低，中间,和高)是根据Preop-D-Roberts-FRS的临床适用性确定的，CR-POPF的相应发生率为0%(0/24)，30%（21/70），和66.7%(14/21)，分别。
结论：推导的C-FRS模型显示出准确预测CP后CR-POPF发展的潜力。然而,需要进一步的验证研究来确定最有效的模型.同时,Preop-D-Roberts-FRS由于其易于使用和术前可预测性,因此推荐用于临床实践.
