Development and Validation of a New Nomogram for Predicting Clinically Relevant Postoperative Pancreatic Fistula After P
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ORIGINAL SCIENTIFIC REPORT
Development and Validation of a New Nomogram for Predicting Clinically Relevant Postoperative Pancreatic Fistula After Pancreatoduodenectomy Xi-Tai Huang1 • Chen-Song Huang1 • Chen Liu2,3,4 • Wei Chen1 • Jian-Peng Cai1 • He Cheng2,3,4 Xing-Xing Jiang5 • Li-Jian Liang1 • Xian-Jun Yu2,3,4 • Xiao-Yu Yin1
•
Accepted: 23 August 2020 Ó Socie´te´ Internationale de Chirurgie 2020
Abstract Background There lacks an ideal model for accurately predicting clinically relevant postoperative pancreatic fistula (CR-POPF) after pancreatoduodenectomy (PD). This study aimed at developing a nomogram with high accuracy in predicting CR-POPF after PD. Methods A total of 1182 patients undergoing PD in the First Affiliated Hospital of Sun Yat-sen University (FAHSYSU, n = 762) and Fudan University Shanghai Cancer Center (FUSCC, n = 420) between January 2010 and May 2018 were enrolled. The patients from FAHSYSU were assigned as testing cohort, and those from FUSCC were used as external validation cohort. Univariate and multivariate logistic regression analyses were performed to determine the predictive factors for CR-POPF. Nomogram was developed on the basis of significant predictors. The performance of nomogram was evaluated by area under receiver operating characteristic (ROC) curve (AUC), calibration curve, and decision curve analysis. Results In testing cohort, 87 out of 762 patients developed CR-POPF. Three predictors were significantly associated with CR-POPF, including body mass index C24.0 kg/m2, pancreatic duct diameter \3 mm, and drainage fluid amylase on postoperative day 1 C2484 units/L (all p B 0.001). Prediction of nomogram was accurate with AUC of 0.934 (95% confidence interval [CI]: 0.914–0.950) in testing cohort and 0.744 (95% CI: 0.699–0.785) in external validation cohort. The predictive accuracy of nomogram was better than that of previously proposed fistula risk scores both in testing and external validation cohort (all p \ 0.05). Conclusions The novel nomogram based on three easily available parameters could accurately predict CR-POPF after PD. It would have high clinical value due to its accuracy and convenience.
2
Department of Pancreatic Surgery, Shanghai Cancer Center, Fudan University, 270 DongAn Road, Xuhui, Shanghai 200032, China
3
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
4
Shanghai Pancreatic Cancer Institute, Shanghai, China
5
Department of Hepatobiliary Surgery, The Affiliated Xinyu Hospital, Nanchang University, Xinyu 338025, China
Xi-Tai Huang, Chen-Song Huang, Chen Liu have contributed equally to this article.
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00268-020-05773-y) contains supplementary material, which is available to authorized users. & Xian-Jun Yu [email protected] & Xiao-Yu Yin [email protected] 1
Department of Pancreato-Biliary Surgery, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China
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World J Surg
Introduction Pancreat
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