Comparative study of Alternative Fistula Risk Score (A-FRS) and Fistula Risk Score (FRS) For Predicting the Risk of Postoperative Pancreatic Fistula After Pancreaticoduodenectomy

Abstract

Introduction: Postoperative pancreatic fistula (POPF) remains the most serious complication after pancreatico-duodenectomy (PD) and the risk of developing POPF is more or less equal with different techniques of reconstruction. Various risk calculation models have been developed for predicting / calculating risk of pancreatic fistula. Fistula risk score (FRS), described in 2013 is the most commonly used scoring system for this purpose. Recently alternative fistula score (a-FRS), was developed and validated in western population. Both FRS & a-FRS are developed and validated in western population with predominantly pancreatic head tumors; whereas, in India we mostly encounter periampullary tumors. Aim: to compare the a-FRS and FRS models for predicting POPF. Method: We performed a retrospective analysis from 1stJanuary 2011 to 31stMarch 2018. All the patients undergoing PD with pancreatico-enteric reconstruction by PJ method were included and patients undergoing distal /median/ total pancreatectomy were excluded. A-FRS and FRS scores were calculated and compared with the actual POPF rates (defined by 2016 ISGPS definition). Result: study cohort contained 825 patients with male preponderance. Median age of the study cohort was 55 years. 61.8% tumors were located in periampullary region and 77.4% were adenocarcinoma. Overall CR-POPF rate in our study population was 16.8% and was represented with more accuracy by a-FRS model (p value-0.003). The performance of each model was assessed byarea under the receiver operating curve (AUC) and calibration plots. Conclusion: a-FRS model performed better in as compared to FRS model (AUC- 0.70 Vs 0.65, p value-0.003) for prediction of POPF but, AUC’s of both the models were still not the best for the perfect prediction model.