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Minerva Surgery 2022 August;77(4):354-9

DOI: 10.23736/S2724-5691.21.09001-8


lingua: Inglese

An easy-to-use score to predict clinically relevant postoperative 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 C. 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, University of Naples Federico II, 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-) postoperative pancreatic fistula (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: Thirty-three 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 >10 mm and if the BMI was >30. The discriminating ability was tested on the ROC curve, showing an area under the curve of 0.83 (95% CI: 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% (95% CI: 69-95) and the specificity at 71 (95% CI: 61-82). A threshold of 3 points/4 allows to reach a specificity of 99% (95% CI: 99-100).
CONCLUSIONS: An easy-to-use postoperative 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: Pancreatic fistula; Pancreatectomy; Risk factors

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