Ann Surg Treat Res.  2020 Feb;98(2):72-81. 10.4174/astr.2020.98.2.72.

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

• Guo CX
• Shen YN
• Zhang Q
• Zhang XZ
• Wang JL
• Gao SL
• Lou JY
• Que RS
• Ma T
• Liang TB
• Bai XL

• KMID: 2469106
• DOI: http://doi.org/10.4174/astr.2020.98.2.72

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.

Keyword

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

MeSH Terms

Cohort Studies
Humans
Multivariate Analysis
Nomograms*
Pancreas
Pancreatic Ducts
Pancreatic Fistula*
Pancreaticoduodenectomy
Pathology
Portal Vein
Retrospective Studies
Risk Factors

Figure

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  Fig. 1 Nomogram to predict the probability that postoperative pancreatic fistula will develop in patients who have undergone pancreaticoduodenectomy.

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  Fig. 2 Calibration curves comparing predicted and actual probabilities of postoperative pancreatic fistula in the training cohort (A) and in the validation cohort (B).

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  Fig. 3 Comparison of the accuracy of the prediction of postoperative pancreatic fistula development in the validation cohort between the nomogram (A) and the conventional models, Callery's model [7] (B) and Mungroop's model [21] (C). AUC, area under curve.

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