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Minerva Surgery 2021 Oct 25

DOI: 10.23736/S2724-5691.21.09001-8


language: English

An easy-to-use score to predict Clinically Relevant Post-Operative Pancreatic Fistula after distal pancreatectomy

Nicolas ROLLIN 1, Gianluca CASSESE 2, 3, Guillaume PINETON DE CHAMBRUN 1, Chris SERRAND 4, Francis NAVARRO 2, Pierre BLANC 1, Fabrizio PANARO 2 , Jean Christoph VALATS 1

1 Department of Gastroenterology and Hepatology, Montpellier University Hospital, Montpellier, France; 2 Department of HPB surgery and liver transplantation, Montpellier University Hospital, Montpellier, France; 3 Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy; 4 Department of Statistics, Montpellier University, Montpellier, France


BACKGROUND: Postoperative Pancreatic Fistula (POPF) is a common and serious complication after Distal Pancreatectomy (DP). An effective and accepted score to predict the occurrence of Clinically Relevant (CR-) POPF does not exist.
METHODS: Data regarding 103 consecutive patients undergoing DP from 2015 to 2019 were collected. A multivariate logistic regression was performed, in order to build a simplified score. The accuracy in predicting a categorical outcome was evaluated using the Receiver Operating Characteristic (ROC) curves. Youden's J test was performed to evaluate the performance of a positive score on the POPF occurrence.
RESULTS: 33 patients developed a CR-POPF. Based on multivariate analysis results, a 4 points score was created by assigning 1 point if operation time was >4 hours, amylase levels on drains’ fluid >500 UI on POD 3, pancreatic thickness >10mm and if the BMI was > 30. The discriminating ability was tested on the ROC curve, showing an area under the curve of 0.83 (CI 95%=0.75 - 0.92). The score threshold was determined at 2 points/4, the highest value according to the Youden index (0.53). The sensitivity is calculated at 82% (CI95% 69-95) and the specificity at 71 (CI95% 61 - 82). A threshold of 3 points/4 allows to reach a specificity of 99% (CI95% 99 - 100).
CONCLUSIONS: An easy to use post-operative score based on operation time, obesity, amylase level on drains on POD3 and pancreatic thickness on preoperative CT seems to predict the risk of developing CR-POPF.

KEY WORDS: POPF; Distal Pancreatectomy; Risk score

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