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Prediction of postoperative pancreatic fistula using a nomogram based on the updated definition

Annals of Surgical Treatment and Research 2020년 98권 2호 p.72 ~ 81
 ( Guo Cheng-Xiang ) - Zhejiang University School of Medicine First Affiliated Hospital Department of Hepatobiliary and Pancreatic Surgery

 ( Shen Yi-Nan ) - Zhejiang University School of Medicine First Affiliated Hospital Department of Hepatobiliary and Pancreatic Surgery
 ( Zhang Qi ) - Zhejiang University School of Medicine First Affiliated Hospital Department of Hepatobiliary and Pancreatic Surgery
 ( Zhang Xiao-Zhen ) - Zhejiang University School of Medicine First Affiliated Hospital Department of Hepatobiliary and Pancreatic Surgery
 ( Wang Jun-Li ) - Zhejiang University School of Medicine First Affiliated Hospital Department of Hepatobiliary and Pancreatic Surgery
 ( Gao Shun-Liang ) - Zhejiang University School of Medicine First Affiliated Hospital Department of Hepatobiliary and Pancreatic Surgery
 ( Lou Jian-Ying ) - Zhejiang University School of Medicine Second Affiliated Hospital Department of Hepatobiliary and Pancreatic Surgery
 ( Que Ri-Sheng ) - Zhejiang University School of Medicine First Affiliated Hospital Department of Hepatobiliary and Pancreatic Surgery
 ( Ma Tao ) - Zhejiang University School of Medicine First Affiliated Hospital Department of Hepatobiliary and Pancreatic Surgery
 ( Liang Ting-Bo ) - Zhejiang University School of Medicine First Affiliated Hospital Department of Hepatobiliary and Pancreatic Surgery
 ( Bai Xue-Li ) - Zhejiang University School of Medicine First Affiliated Hospital Department of Hepatobiliary and Pancreatic Surgery

Abstract


Purpose: The International Study Group on Pancreatic Fistula's definition of postoperative pancreatic fistula (POPF) has recently been updated. This study aimed to identify risk factors for POPF in patients having pancreaticoduodenectomy (PD) and to generate a nomogram to predict POPF.

Methods: Data on 298 patients who underwent PD from March 2012 to October 2017 was retrospectively reviewed and POPF statuses were redefined. A nomogram was constructed using data from 220 patients and validated using the remaining 78 patients. Independent risk factors for POPF were identified using univariate and multivariate analyses. A predictive nomogram was established based on the independent risk factors and was compared with existing models.

Results: Texture of the pancreas, size of the main pancreatic duct, portal vein invasion, and definitive pathology were the identified risk factors. The nomogram had a C-index of 0.793 and was internally validated. The nomogram performed better (C-index of 0.816) than the other most cited models (C-indexes of 0.728 and 0.735) in the validation cohort. In addition, the nomogram can assign patients into low- (less than 10%), intermediate- (10% to 30%), and high-risk (equal or higher than 30%) groups to facilitate personalized management.

Conclusion: The nomogram accurately predicted POPF in patients having PD.

키워드

Clinical prediction; Nomograms; Pancreatic fistula; Risk factors; Surgery
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