External validation of four different models of prediction the clinically relevant pancreatic fistula after laparoscopic pancreatoduodenectomy

Abstract

Introduction: Different models were proposed to predict clinically relevant postoperative pancreatic fistula (CR-POPF) development after open pancreatoduodenectomy. Among them are the Fistula Risk Score (FRS), Alternative Fistula Risk Score (a-FRS), Updated Alternative Fistula Risk Score (ua-FRS), Japanese Fistula Risk Score (JFRS). External validations of these scales applying to laparoscopic procedure should be performed. Purpose: Is to perform external validations of different scales of prediction CR-POPF after LPDE. Methods: From 2007 to 2018, 290 LPDEs were performed at single institution. The individual risk scores according different scales were calculated for each patient, and clinical outcomes were evaluated. Receiver operator curve analysis was performed to judge model validity Results: Out of 290 patients, 60 (20,7%) developed CR-POPF (15,9 % grade B, 4,8 % grade C). The incidences of CR-POPF in patients classified as negligible risk, low risk, intermediate risk, and high-risk by original-FRS were 4%, 8.2%, 26%, and 45%, respectively. The area under the ROC curve (AUC) was 0.745 for a-FRS vs. 0.70 for original-FRS. The incidences of CR-POPF in patients classified as low risk, moderate risk, and high-risk by a-FRS were 7,5%, 23,9%, and 44%, respectively. The AUC was 0.748. In patients who developed CR-POPF the mean ua-FRS score was 43,5%±21,9 vs 23,9%±18,7 for patients who did not suffer from CR-POPF (р< 0,0001). The AUC for ua-FRS was 0,772. The AUC of J-FRS, which was originally developed for the prediction of grade C POPF, was 0,692, showing low predictive value of this scale for LPDE. Conclusion: The ua-FRS appears to be the most accurate and convenient tool for predicting occurrence of CR-POPF after LPDE.