Periampullary Carcinoma Research Articles

Rate And Grade of Postoperative Pancreatic Fistula After Modified Blumgart Pancreaticojejunostomy in Pancreaticoduodenectomy

Introduction: Pancreaticoduodenectomy (PD), commonly known as the Whipple procedure, is the standard surgical approach for treating pancreatic and periampullary cancers. Despite advancements in surgical techniques, postoperative pancreatic fistula (POPF) remains one of the most significant complications following PD, contributing to increased morbidity. This study aims to evaluate the development and severity of POPF in patients undergoing PD with the Modified Blumgart Pancreaticojejunostomy. Methods: This Cross-sectional Observational study was carried out among the indoor patients of surgery units in Dhaka Medical College & Hospital, Dhaka, from January 2023 to December 2023. All patients who experienced Pancreatoduodenectomy in the Surgery department of Dhaka Medical College & Hospital during the study period were considered as the study population. A total of 30 patients were selected as study subjects by purposive sampling technique. Consent from patients and relevant authorities was taken. Univariate and multivariate analysis of the data was carried out using a statistical analysis software program. Descriptive analysis of continuous variables was carried out and showed as the means ± SD. Result: This study involved 30 patients, with the majority (36.6%) aged between 40-50 years and male predominance (63.3%). Most patients (50%) were diagnosed preoperatively with periampullary carcinoma, followed by pancreatic carcinoma (40%). Postoperative pancreatic fistula occurred in 13.3% of patients, with the majority (75%) being Grade B fistulas, and 25% classified as Grade A. No Grade C fistulas were observed. Conclusion: Placing sutures between the pancreatic tissue and the jejunum carries a risk of pancreatic juice leakage due to needle holes or injury to the pancreatic tissue, particularly in patients with a soft pancreas. Therefore, this study suggests that an anastomosis technique utilizing fewer sutures may be more advantageous. The original Blumgart anastomosis employed four to six trans pancreatic/jejunal seromuscular sutures, whereas our approach utilized only one to three. Additionally, the modified Blumgart technique ensured complete coverage of the pancreatic stump with jejunal serosa through the modified lateral suture that penetrates the seromuscular layer of the jejunum

Intra-ampullary and Periampullary Carcinoma: Clinicopathological Comparison and Survival Outcomes.

Introduction The ampulla of Vater is a structure in the duodenal wall in which the biliary and pancreatic ducts open. Malignant epithelial tumors arising at this site are commonly referred to as ampullary adenocarcinomas. In this study, we compared the clinicopathological features of intra-ampullary and periampullary carcinomas, including survival outcomes. Methods This retrospective cross-sectional study was conducted at the Department of Pathology, Liaquat National Hospital. All radiologically suspected cases or biopsy-proven (endoscopic biopsy) cases of intra-ampullary/periampullary carcinoma were included in the study. All patients underwent surgical resection (Whipple's procedure/pancreatoduodenectomy). The classification of intra-ampullary and periampullary carcinomas was performed according to the College of American Pathologists (CAP) guidelines. Results Among the 188 case studies, most (61.7%, n = 116) were males, with a median age of 55 years. Most tumors were ofthe pancreatobiliary subtype (57.4%, n = 108). Similarly, intra-ampullary carcinoma was more common than periampullary carcinoma (61.7% vs. 38.3%). Intra-ampullary carcinoma showed a higher extent of involvement of adjacent structures, a higher frequency of perineural invasion, and a higher nodal stage than periampullary carcinoma. Similarly, the median disease-specific survival of intra-ampullary carcinoma was significantly lower (46 months) than that of periampullary carcinoma (53.5 months). Conclusion We found a higher incidence of intra-ampullary carcinoma in our study. In addition, intra-ampullary carcinoma had a worse survival rate and was associated with poorer pathological parameters, such as perineural invasion and higher nodal and tumor stages than periampullary carcinoma.

Molecular aspects of BRAF and HER2 in prognosis of periampullary carcinoma

BackgroundBiological behaviour of Periampullary cancers (PACS) differs from pancreatic head cancer, and analysis of molecular alteration is needed. BRAF and HER2 are keys members of the RAS/RAF and EGFR pathway, playing roles in prognostic markers and therapeutic targets. MethodsA study on 89 PACS patients, undergoing Whipple Pancreaticoduodenectomy, PCR-RFLP, and qPCR methods used for SNP and mRNA expression studies. Clinicopathological and survival data collected. Molecular changes were correlated with Clinicopathological parameters. Survival outcomes were assessed by Kaplan Meir Log rank test. ResultsThe study revealed that homozygous mutant BRAF V600E was significantly higher in PAC compared to a healthy control (p = 0.0012). Whereas the genotype frequency of HER2 I1655V was similar among PAC and healthy control. The A > G change in HER2 was associated with tumor arising from duodenum (p = 0.004) and showed poor survival outcome (p = 0.001). Upregulation of BRAF and HER2 was found in 43 % of patients with synergistic effect, the median overall survival (OS) being 50.5 ± 13 months. The increased expression of HER2 was higher in early stage (p = 0.04) PAC. The gene expression did not impact the OS, whereas female gender, G3 tumors, T3-T4 depth of tumour, advanced stage, LN metastasis, LVI and PNI were poor predictors of OS. ConclusionsBRAF V600E SNP was associated with disease susceptibility, and had increased mRNA expression while HER2 I1655V SNP was associated with poor survival outcome in PAC. The increased expression of BRAF and HER2 in early tumors and their co-expression in PAC exhibit cross talk between RAS/RAF and EGFR pathway in PAC.

Study of cases of obstructive jaundice due to biliary and pancreatic tumors

Obstructive jaundice has recently become more common, particularly among malignant cases. The aim was to study, evaluate and compare various operative managements for obstructive jaundice due to biliary and pancreatic tumors. This prospective study was conducted by random selection of 20 cases presenting with obstructive jaundice due to biliary and pancreatic tumors at a tertiary care hospital affiliated with Smt. N.H.L. Municipal Medical College. Majority of patients were in age group 51-60 years (35%) and 61-70 years (20%). Males (70%) were found to be in higher proportion compared to females (30%). Most comm on presenting symptom was jaundice (90%). Most common cause was periampullary carcinoma (60%). It was found that the most common complication following Whipple’s procedure and Triple Bypass Surgery was pancreatic fistula.

Prognostic significance of histologic phenotype in periampullary adenocarcinomas.

Periampullary adenocarcinomas typically exhibit either intestinal or pancreatobiliary (PB) differentiation, and the type of differentiation may be prognostically more important than the anatomic site of origin. This study aimed to evaluate prognostic significance of histological type of periampullary carcinomas. Microscopic slides from 110 consecutive pancreatoduodenectomies performed between 2010 and 2020 were reviewed and classified as intestinal or PB type. Clinicopathological factors were compared between PB-(n=93) and intestinal-type (n=17) differentiation. The intestinal type included significantly more patients with well-differentiated histology (35.3% vs. 11.8%, p=0.001) and fewer patients with perineural invasion (41.2% vs. 76.4%, p=0.029), advanced T stage (> T3; 41.2% vs.74.2%, p=0.007), and systemic recurrence (71.4% vs. 92.9%, p=0.005) than PB type. The 5-year-overall survival rate of intestinal-type was significantly higher than that of PB-type (58.8% vs. 20.4%, p=0.003). When pancreatic cancer was separately analyzed, the intestinal type showed the best 5-year-overall survival rate, with no significant difference between the PB types excluding PDAC and PDAC (39.4% vs. 19.2%, p=0.148). In multivariate analysis, curative resection (hazard ratio, 0.417; 95% CI, 0.219-0.792, p=0.008) was the only significant prognostic factor. Although intestinal histologic phenotype was not an independent prognostic factor on multivariate analysis, it showed pathologic features associated with better survival, while the PB type showed more aggressive tumor biology and consequently worse survival. Further studies are needed to demonstrate the prognostic significance of histologic phenotype.

Laparoscopic versus open pancreaticoduodenectomy: Long-term outcome from a tertiary care centre.

Laparoscopic Whipple's pancreaticoduodenectomy (WPD) is one of the most advanced minimally invasive procedures. In recent years, with advancements in minimally invasive surgery, laparoscopic WPD has been increasingly adopted as a safe and feasible technique. This study aims to compare the short-term and long-term outcomes of laparoscopic WPD to open WPD in resectable ampullary, periampullary and head of pancreas malignancies. A retrospective analysis of a prospectively maintained database of patients who underwent WPD from January 2015 to January 2021 at the department of surgical gastroenterology in a tertiary care medical college hospital was conducted. Patient demographics and pre-operative details, intraoperative parameters (operating time and blood loss), post-operative length of hospital stay, median intensive care unit (ICU) stay, time to resume oral diet, post-operative complications, interventional procedures, mortality, 3-year survival, 3 year recurrence-free survival and overall survival were analysed. Forty-two patients underwent WPD during our study period; 14 patients underwent laparoscopic WPD and 28 patients underwent open WPD. None required conversion. The majority of the patients had periampullary carcinoma in both the groups. Laparoscopic WPD showed a trend towards shorter ICU stays, hospital stays and surgical site infections (SSIs) compared to open WPD. The median operating time was significantly longer in the laparoscopic WPD group (380 min) compared to the open group (285 min). However, median blood loss was significantly lower in the laparoscopic group (250 mL vs. 300 mL). The pancreas-specific post-operative complications like delayed gastric emptying, post-operative pancreatic fistula or post-operative pancreatic haemorrhage did not differ significantly between the groups. All patients had R0 resection and the mean lymph node yield was comparable between the two groups (14.92 vs. 13.42). The reoperation rate or mortality rate did not show any statistical significance between the two groups. The overall survival was 46 months in the open group and 48 months in the laparoscopic group. Three-year survival was 74.1% in the open WPD group and 69.2% in the laparoscopic group. Three-year recurrence-free survival was 55.5% in the open group and 69.23% in the laparoscopic group. Laparoscopic WPD appears to be safe and feasible, with similar short-term and long-term survival outcomes. With a trend favouring laparoscopic WPD in terms of blood loss, hospital and ICU stay and post-operative SSIs, it should be offered to selected patients when the expertise is available.

Unnecessary Pancreatic Resection for Non-cancerous Lesions Masquerading as Pancreatic and Peri-ampullary Cancers: An Inevitable Circumstance

Background: Pancreatic and peri-ampullary cancers are deadly and require surgery. Some non-cancerous conditions, especially those that do not require surgery, have imaging findings similar to pancreatic and peri-ampullary carcinoma. The proportion of non-cancerous lesions that undergo pancreatic resection for suspected pancreatic or peri-ampullary cancer is scarce in eastern countries, especially when bile duct tumors are common. This study examined the proportion of non-cancerous lesions removed during pancreatic resection for suspected pancreatic or peri-ampullary cancer. Materials and Methods: The retrospective study included January 2013–December 2017. We investigated the medical and pathological data of 148 pancreatic resection patients at Srinagarind Hospital, Khon Kaen University. Results: Nine patients (6.1%) had postoperative pathology diagnoses that did not require surgery. The discordant group was significantly larger among distal pancreatectomy or enucleation patients (15%, 4/27) than pancreaticoduodenectomy patients (4.1%, 5/121). The concordant and discordant groups had similar clinical features for pancreaticoduodenectomy, except for gender (p=0.031). There were no clinical differences between concordant and discordant patients after distal pancreatectomy or enucleation. Conclusion: Pancreatic excision for non-cancerous conditions may be inevitable. Western and Eastern countries have different non-cancerous disorders that mimic pancreatic or peri-ampullary cancer. Western countries had more pancreatic conditions, especially inflammatory ones, but Eastern countries had more ampullary and bile duct conditions in pancreaticoduodenectomy patients and benign cystic lesions in distal pancreatectomy patients.

Impact of biliary drainage method before pancreaticoduodenectomy on short- and long-term outcomes in patients with periampullary carcinoma and obstructive jaundice: A multicenter retrospective analysis

BackgroundThe optima preoperative biliary drainage before pancreaticoduodenectomy in patients with biliary tract and pancreatic cancer remains controversial. MethodsA total of 898 patients who underwent preoperative biliary drainage via endoscopic retrograde biliary drainage, endoscopic transnasal biliary drainage, or percutaneous transhepatic biliary drainage before pancreaticoduodenectomy for biliary tract and pancreatic cancer were included. Perioperative and long-term outcomes were analyzed. ResultsThe Clavien-Dindo grade ≥3 morbidity rates after pancreaticoduodenectomy were higher in the endoscopic retrograde biliary drainage (21.9%; P = .001) or endoscopic transnasal biliary drainage (20.2%; P = .007) than in the percutaneous transhepatic biliary drainage (9.7%) groups. In biliary tract cancer, the frequency of dissemination after pancreaticoduodenectomy was higher in the percutaneous transhepatic biliary drainage (15.3%) than in the endoscopic retrograde biliary drainage (0.7%; P = .001) and endoscopic transnasal biliary drainage (4.1%; P = .037) groups; percutaneous transhepatic biliary drainage was an independent factor associated with worse disease-free survival (P = .04), whereas in pancreatic cancer the frequency of dissemination and survival was comparable among the 3 preoperative biliary drainage methods. Albumin <3.9 g/dL was independently associated with worse overall survival in patients with both pancreatic (P = .038) and biliary tract (P = .002) cancers, respectively. During biliary drainage, external drainage (P = .038) was independently associated with albumin <3.9 g/dL; albumin was higher in endoscopic retrograde biliary drainage group than in endoscopic transnasal biliary drainage or percutaneous transhepatic biliary drainage groups after 21 days from tube insertion. ConclusionIn biliary tract cancer, percutaneous transhepatic biliary drainage may carry the risk of increasing the incidence of disseminative recurrence. In pancreatic cancer, percutaneous transhepatic biliary drainage is preferable owing to fewer complications without influencing recurrence. However, if patients cannot undergo surgery immediately, endoscopic retrograde biliary drainage will be applicable to help the preservation of nutritional status, which can have an impact on survival.

Profile of breast cancer in patients with Li-Fraumeni syndrome: An institutional experience.

e13042 Background: Li Fraumeni syndrome (LFS) is a rare autosomal dominant syndrome, associated with multisystem cancer predisposition. Considering the rarity of this syndrome, studies are very sparse on survival outcomes of breast cancer with germline TP53 mutation and there exists discrepancy amongst the results. Methods: This retrospective observational study included 17 patients with germline TP53 mutated breast cancer registered at All India Institute of Medical Sciences (AIIMS), New Delhi, India between the period of 1st April 2016 to 31st Dec 2023. Among the 577 high-risk breast cancer patients, who underwent germline mutation testing, 231 (40.03%) cases had pathogenic mutation [145(25.12%) were BRCA mutated,15 (2.59%) were TP53 mutated, and the rest were others pathogenic variant]. All the TP53 mutations were crosschecked via the ClinVar mutation database to be classified as pathogenic. Results: The median age of 15 patients was 31 years (23-55) and 12 (80%) cases were premenopausal. All the patients had breast cancer as the index malignancy. The Stage distribution (AJCC-7th edition) Stage I, 1(6.6%); Stage II, 7 (46.6 %); Stage III, 4 (26.6 %); and Stage IV, 3 (20 %). Eight cases (53.3%) were HER2 positive, 4 (26.6%) were hormone receptor-positive, and 3 (20%) were Triple-negative breast carcinoma (TNBC). Ten (10) patients received neoadjuvant chemotherapy and 6 (60%) had a complete pathological response. Eight cases (53.3%) cases had a significant family history with 9 (60%) of them having at least one first-degree relative with cancer and two had more than one first-degree relative with cancer. One patient had a family history of LFS. The most common familial cancer was breast, followed by lung, GI malignancies, brain tumor, and sarcoma. Synchronous breast cancer was seen in 2 patients, synchronous malignancies were seen in 4 cases (one patient: each with lung adenocarcinoma, periampullary carcinoma, carcinoma colon, and synovial sarcoma, along with breast cancer), Four patients (26.6%) had metachronous cancers: lung cancer, ovarian carcinoma, contralateral breast cancer, and high-grade sarcoma respectively. The most common mutations were point mutations ( n = 11, 73.3%) followed by frameshift mutations ( n = 4, 26.6%). The subtypes of point mutations included missense mutations ( n = 9) and nonsense mutations ( n = 2) with the most common aberration being a replacement of arginine with glycine (c.743G&gt;A, p. Arg248Gln) and locus being exon 7. The median disease-free survival was 41 months and progression-free survival was 15 months. Conclusions: The prevalence of TP53 mutation in our breast cancer patients is 2.5%. With standard treatment protocols, the overall survival of LFS-associated breast cancer is similar to the historic cohort of patients without any germline mutation. Active surveillance of the patient and family screening is imperative, for all positive cases.

310P Pattern of care and outcomes in periampullary carcinoma in the Indian Subcontinent: A retrospective observational study

310P Pattern of care and outcomes in periampullary carcinoma in the Indian Subcontinent: A retrospective observational study

Clinical Significance of MUC4 and Associated Proteins in Pancreatic and Periampullary Cancers.

This study primarily aimed to assess the expression of MUC4 in patients with pancreatic ductal adenocarcinoma (PDAC) as compared with controls and assess its clinical relevance. Serum MUC4 levels and MUC4 gene expression in snap-frozen tissue were analyzed through surface plasmon resonance and quantitative polymerase chain reaction, respectively. Tumor tissues and control tissues were analyzed for MUC4 and other mucins through immunohistochemistry. MUC4 expression in tumor tissue was found to be significantly elevated in PDAC patients as compared with chronic pancreatitis tissues and normal pancreatic tissues. Periampullary carcinoma and cholangiocarcinoma tissue also showed increased expression of MUC4 and other mucins. Differential expression of MUC4 in pancreatic tumor tissues can help to differentiate PDAC from benign conditions.

Role of adjuvant therapy in resected periampullary adenocarcinoma: A propensity matched case-control study.

The published data had contradictory information on the role of adjuvant therapy on resected periampullary carcinomas (PACA). The study was performed to evaluate the survival benefit of adjuvant treatment. This was a propensity score matched case-control study from a prospectively maintained database from 2004-2019. The study included patients with nonpancreatic PACA who underwent curative resection. The patients (cases) who received adjuvant chemotherapy were compared with patients (controls) who were observed alone after surgery. Of 510 patients with PACA, 230 patients (cases = 107, controls = 123) formed the unmatched study cohort. After propensity score matching, 140 patients (cases = 70, controls = 70) formed the matched study cohort. The median overall survival (OS) was similar in cases than controls in the unmatched population but doubled non-significantly in cases after matching (unmatched population, 54 months vs. 54 months, p-value = 0.624; matched population, 71 months vs. 36 months, p-value = 0.087). However, the median recurrence-free survival (RFS) was non significantly higher in the control group (unmatched population, 59 months vs. 38 months, p-value = 0.195; matched population, 53 months vs. 40 months, p-value = 0.797). In cox regression analysis, age < 60 years, advanced T stage, and presence of perineural invasion were independent factors for worse RFS, while tumor recurrence was an independent factor for poor OS. Patients with nonpancreatic PACA may have an OS benefit from adjuvant chemotherapy, and this needs to be validated with large prospective randomized studies.

An unusual case report of metastatic periampullary carcinoma

Pancreatic cancers usually metastasize through the lymphoid system to organs such as the lung, liver, bone and spleen. Ovarian metastasis in pancreatic cancers is extremely rare, hence, it is difficult to distinguish between primary and metastatic ovarian tumors, especially in tumors with a primary source from the GIT &amp; Hepatobiliary system. We present the case of a periampullary carcinoma with ovarian metastasis in a middle-aged female who presented with complaints of abdominal pain, constipation, yellowish discoloration of eyes and dark colored urine along with loss of appetite and weight loss for a duration of 6 to 8 weeks. Radiological examination revealed right adnexal lesion and nodular thickening along periampullary region. ERCP guided biopsy of the growth in periampullary region revealed moderately differentiated adenocarcinoma. She underwent pancreatico-duodenectomy with bilateral salpingo-oophorectomy. The histopathological examination revealed invasive carcinoma in both the ovaries, and moderately differentiated adenocarcinoma in periampullary and intra-ampullary region. As per the findings in previous studies, bilateral ovarian tumors of any size, or a unilateral tumor less than 10 cm likely represents metastatic disease rather than primary ovarian tumor. The rarity of co-presentation of pancreatic and adnexal mass makes the diagnosis tough however it is important to differentiate between primary ovarian mucinous cancers and ovarian metastasis from primaries in GIT for further treatment and follow up.

Comparison of short-term outcomes of open and laparoscopic assisted pancreaticoduodenectomy for periampullary carcinoma: A propensity score-matched analysis.

Postoperative pancreatic fistula is the key worry in the ongoing debate about the safety and effectiveness of total laparoscopic pancreaticoduodenectomy (TLPD). Laparoscopic-assisted pancreaticoduodenectomy (LAPD), a hybrid approach combining laparoscopic resection and anastomosis with a small incision, is an alternative to TLPD. This study compares the short-term outcomes and oncological efficacy of LAPD vs. open pancreaticoduodenectomy (OPD). A retrospective analysis of data of all patients who underwent LAPD or OPD for periampullary carcinoma at a tertiary care center in Northeast India from July 2019 to August 2023 was done. A total of 30 LAPDs and 30 OPDs were compared after 1:1 propensity score matching. Demographic data, intraoperative and postoperative data (30 days), and pathological data were compared. The study included a total of 93 patients, 30 underwent LAPD and 62 underwent OPD. After propensity score matching, the matched cohort included 30 patients in both groups. The LAPD presented several advantages over the OPD group, including a shorter incision length, reduced postoperative pain, earlier initiation of oral feeding, and shorter hospital stays. LAPD was not found to be inferior to OPD in terms of pancreatic fistula incidence (Grade B, 30.0% vs. 33.3%), achieving R0 resection (100% vs. 93.3%), and the number of lymph nodes harvested (12 vs. 14, p = 0.620). No significant differences in blood loss, short-term complications, pathological outcomes, readmissions, and early (30-day) mortality were observed between the two groups. LAPD has comparable safety, technical feasibility, and short-term oncological efficacy.

Machine learning for differentiating between pancreatobiliary-type and intestinal-type periampullary carcinomas based on CT imaging and clinical findings

PurposeTo develop a diagnostic model for distinguishing pancreatobiliary-type and intestinal-type periampullary adenocarcinomas using preoperative contrast-enhanced computed tomography (CT) findings combined with clinical characteristics.MethodsThis retrospective study included 140 patients with periampullary adenocarcinoma who underwent preoperative enhanced CT, including pancreaticobiliary (N = 100) and intestinal (N = 40) types. They were randomly assigned to the training or internal validation set in an 8:2 ratio. Additionally, an independent external cohort of 28 patients was enrolled. Various CT features of the periampullary region were evaluated and data from clinical and laboratory tests were collected. Five machine learning classifiers were developed to identify the histologic type of periampullary adenocarcinoma, including logistic regression, random forest, multi-layer perceptron, light gradient boosting, and eXtreme gradient boosting (XGBoost).ResultsAll machine learning classifiers except multi-layer perceptron used achieved good performance in distinguishing pancreatobiliary-type and intestinal-type adenocarcinomas, with the area under the curve (AUC) ranging from 0.75 to 0.98. The AUC values of the XGBoost classifier in the training set, internal validation set and external validation set are 0.98, 0.89 and 0.84 respectively. The enhancement degree of tumor, the growth pattern of tumor, and carbohydrate antigen 19–9 were the most important factors in the model.ConclusionMachine learning models combining CT with clinical features can serve as a noninvasive tool to differentiate the histological subtypes of periampullary adenocarcinoma, in particular using the XGBoost classifier.

Comparison of blood loss during laparoscopic and open pancreaticoduodenectomy in patients with periampullary carcinoma – a randomized clinical trial

Comparison of blood loss during laparoscopic and open pancreaticoduodenectomy in patients with periampullary carcinoma – a randomized clinical trial

Comparison of Open and Laparoscopic assisted Pancreaticoduodenectomy for periampullary carcinoma – A Propensity score-matched analysis

Comparison of Open and Laparoscopic assisted Pancreaticoduodenectomy for periampullary carcinoma – A Propensity score-matched analysis

Prediction of pancreatic fstula after pancreatoduodenectomy using machine learning

Objective: to analyze the results of pancreatoduodenectomy (PD) and identify predictive risk factors for postoperative pancreatic fistula (PF) using machine learning (ML) technology.Material and Methods. A nonrandomized study of treatment outcomes in 128 patients, who underwent PD for periampullary carcinoma between 2018 and 2023, was conducted. To predict PF, the ML models based on the multilayer perceptron and binary logistic regression (BLR) in SPSS Statistics v.26, were used. The Receiver Operator Characteristics (ROC) analysis was used to assess the accuracy of the models. To compare ROC curves, the DeLong test was used.Results. Clinically significant PF occurred in 19 (14.8 %) patients (grade B according to ISGPS 2016 – in 16 (12.5 %), grade C – in 3 (2.3 %)). The data of 90 (70.3 %) patients were used to train the neural network, and 38 (29.7 %) were used to test the predictive model. In multivariate analysis, the predictors of PF were a comorbidity level above 7 points on the age-adjusted Charlson scale, a diameter of the main pancreatic duct less than 3 mm, and a soft pancreatic consistency. The diagnostic accuracy of the ML model estimated using the area under the ROC curve was 0.939 ± 0.027 (95 % CI: 0.859–0.998, sensitivity: 84.2 %, specificity; 96.3 %). The predictive model, which was developed using BLR, demonstrated lower accuracy: 0.918±0.039 (95 % CI: 0.842–0.994, sensitivity: 78.9 %, specificity: 94.5 %) (p=0.02).Conclusion. The use of machine learning technologies makes it possible to increase the probability of a correct prediction of the occurrence of pancreatic fistula after pancreatoduodenectomy.

A Prospective Observational Study on the Impact of Sarcopenia on Perioperative Outcomes following Pancreaticoduodenectomy for Periampullary Carcinoma

A Prospective Observational Study on the Impact of Sarcopenia on Perioperative Outcomes following Pancreaticoduodenectomy for Periampullary Carcinoma

A prospective observational study on the impact of sarcopenia on perioperative outcomes following pancreaticoduodenectomy for periampullary carcinoma

A prospective observational study on the impact of sarcopenia on perioperative outcomes following pancreaticoduodenectomy for periampullary carcinoma