Abstract
Objective: The aim of the study was to validate and optimize the alternative Fistula Risk Score (a-FRS) for patients undergoing minimally invasive pancreatoduodenectomy (MIPD) in a large pan-European cohort. Background: MIPD may be associated with an increased risk of postopera-tive pancreatic fistula (POPF). The a-FRS could allow for risk-adjusted comparisons in research and improve preventive strategies for high-risk patients. The a-FRS, however, has not yet been validated specifically for laparoscopic, robot-assisted, and hybrid MIPD. Methods: A validation study was performed in a pan-European cohort of 952 consecutive patients undergoing MIPD (543 laparoscopic, 258 robot-assisted, 151 hybrid) in 26 centers from 7 countries between 2007 and 2017. The primary outcome was POPF (International Study Group on Pancreatic Surgery grade B/C). Model performance was assessed using the area under the receiver operating curve (AUC; discrimination) and calibration plots. Validation included univariable screening for clinical variables that could improve performance. Results: Overall, 202 of 952 patients (21%) developed POPF after MIPD. Before adjustment, the original a-FRS performed moderately (AUC 0.68) and calibration was inadequate with systematic underestimation of the POPF risk. Single-row pancreatojejunostomy (odds ratio 4.6, 95 confidence interval [CI] 2.8-7.6) and male sex (odds ratio 1.9, 95 CI 1.4-2.7) were identified as important risk factors for POPF in MIPD. The updated a-FRS, consisting of body mass index, pancreatic texture, duct size, and male sex, showed good discrimination (AUC 0.75, 95 CI 0.71-0.79) and adequate calibration. Performance was adequate for laparoscopic, robot-assisted, and hybrid MIPD and open pancreatoduodenectomy. Conclusions: The updated a-FRS (www.pancreascalculator.com) now includes male sex as a risk factor and is validated for both MIPD and open pancreatoduodenectomy. The increased risk of POPF in laparoscopic MIPD was associated with single-row pancreatojejunostomy, which should therefore be discouraged.
| Original language | English |
|---|---|
| Journal | Annals of Surgery |
| Volume | 273 |
| Issue number | 2 |
| Pages (from-to) | 334-340 |
| Number of pages | 7 |
| ISSN | 0003-4975 |
| DOIs | |
| Publication status | Published - 01.02.2021 |
Research Areas and Centers
- Research Area: Luebeck Integrated Oncology Network (LION)
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Mungroop, T., Klompmaker, S., Wellner, U., Steyerberg, E., Coratti, A., D'Hondt, M., De Pastena, M., Dokmak, S., Khatov, I., Saint-Marc, O., Wittel, U., Abu Hilal, M., f*cks, D., Poves, I., Keck, T., Boggi, U., & Besselink, M. (2021). Updated Alternative Fistula Risk Score (ua-FRS) to Include Minimally Invasive Pancreatoduodenectomy: Pan-European Validation. Annals of Surgery, 273(2), 334-340. https://doi.org/10.1097/SLA.0000000000003234
Mungroop, Timothy ; Klompmaker, Sjors ; Wellner, Ulrich et al. / Updated Alternative Fistula Risk Score (ua-FRS) to Include Minimally Invasive Pancreatoduodenectomy: Pan-European Validation. In: Annals of Surgery. 2021 ; Vol. 273, No. 2. pp. 334-340.
@article{a6cc0615d01849bca8f22851176746e5,
title = "Updated Alternative Fistula Risk Score (ua-FRS) to Include Minimally Invasive Pancreatoduodenectomy: Pan-European Validation",
abstract = "Objective: The aim of the study was to validate and optimize the alternative Fistula Risk Score (a-FRS) for patients undergoing minimally invasive pancreatoduodenectomy (MIPD) in a large pan-European cohort. Background: MIPD may be associated with an increased risk of postopera-tive pancreatic fistula (POPF). The a-FRS could allow for risk-adjusted comparisons in research and improve preventive strategies for high-risk patients. The a-FRS, however, has not yet been validated specifically for laparoscopic, robot-assisted, and hybrid MIPD. Methods: A validation study was performed in a pan-European cohort of 952 consecutive patients undergoing MIPD (543 laparoscopic, 258 robot-assisted, 151 hybrid) in 26 centers from 7 countries between 2007 and 2017. The primary outcome was POPF (International Study Group on Pancreatic Surgery grade B/C). Model performance was assessed using the area under the receiver operating curve (AUC; discrimination) and calibration plots. Validation included univariable screening for clinical variables that could improve performance. Results: Overall, 202 of 952 patients (21%) developed POPF after MIPD. Before adjustment, the original a-FRS performed moderately (AUC 0.68) and calibration was inadequate with systematic underestimation of the POPF risk. Single-row pancreatojejunostomy (odds ratio 4.6, 95 confidence interval [CI] 2.8-7.6) and male sex (odds ratio 1.9, 95 CI 1.4-2.7) were identified as important risk factors for POPF in MIPD. The updated a-FRS, consisting of body mass index, pancreatic texture, duct size, and male sex, showed good discrimination (AUC 0.75, 95 CI 0.71-0.79) and adequate calibration. Performance was adequate for laparoscopic, robot-assisted, and hybrid MIPD and open pancreatoduodenectomy. Conclusions: The updated a-FRS (www.pancreascalculator.com) now includes male sex as a risk factor and is validated for both MIPD and open pancreatoduodenectomy. The increased risk of POPF in laparoscopic MIPD was associated with single-row pancreatojejunostomy, which should therefore be discouraged.",
author = "Timothy Mungroop and Sjors Klompmaker and Ulrich Wellner and Ewout Steyerberg and Andrea Coratti and Mathieu D'Hondt and {De Pastena}, Matteo and Safi Dokmak and Igor Khatov and Olivier Saint-Marc and Uwe Wittel and {Abu Hilal}, Mohammad and David f*cks and Ignasi Poves and Tobias Keck and Ugo Boggi and Marc Besselink",
note = "Publisher Copyright: Copyright {\textcopyright} 2019 Wolters Kluwer Health, Inc. All rights reserved.",
year = "2021",
month = feb,
day = "1",
doi = "10.1097/SLA.0000000000003234",
language = "English",
volume = "273",
pages = "334--340",
journal = "Annals of Surgery",
issn = "0003-4975",
number = "2",
}
Mungroop, T, Klompmaker, S, Wellner, U, Steyerberg, E, Coratti, A, D'Hondt, M, De Pastena, M, Dokmak, S, Khatov, I, Saint-Marc, O, Wittel, U, Abu Hilal, M, f*cks, D, Poves, I, Keck, T, Boggi, U & Besselink, M 2021, 'Updated Alternative Fistula Risk Score (ua-FRS) to Include Minimally Invasive Pancreatoduodenectomy: Pan-European Validation', Annals of Surgery, vol. 273, no. 2, pp. 334-340. https://doi.org/10.1097/SLA.0000000000003234
Updated Alternative Fistula Risk Score (ua-FRS) to Include Minimally Invasive Pancreatoduodenectomy: Pan-European Validation. / Mungroop, Timothy; Klompmaker, Sjors; Wellner, Ulrich et al.
In: Annals of Surgery, Vol. 273, No. 2, 01.02.2021, p. 334-340.
Research output: Journal Articles › Journal articles › Research › peer-review
TY - JOUR
T1 - Updated Alternative Fistula Risk Score (ua-FRS) to Include Minimally Invasive Pancreatoduodenectomy: Pan-European Validation
AU - Mungroop, Timothy
AU - Klompmaker, Sjors
AU - Wellner, Ulrich
AU - Steyerberg, Ewout
AU - Coratti, Andrea
AU - D'Hondt, Mathieu
AU - De Pastena, Matteo
AU - Dokmak, Safi
AU - Khatov, Igor
AU - Saint-Marc, Olivier
AU - Wittel, Uwe
AU - Abu Hilal, Mohammad
AU - f*cks, David
AU - Poves, Ignasi
AU - Keck, Tobias
AU - Boggi, Ugo
AU - Besselink, Marc
N1 - Publisher Copyright:Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2021/2/1
Y1 - 2021/2/1
N2 - Objective: The aim of the study was to validate and optimize the alternative Fistula Risk Score (a-FRS) for patients undergoing minimally invasive pancreatoduodenectomy (MIPD) in a large pan-European cohort. Background: MIPD may be associated with an increased risk of postopera-tive pancreatic fistula (POPF). The a-FRS could allow for risk-adjusted comparisons in research and improve preventive strategies for high-risk patients. The a-FRS, however, has not yet been validated specifically for laparoscopic, robot-assisted, and hybrid MIPD. Methods: A validation study was performed in a pan-European cohort of 952 consecutive patients undergoing MIPD (543 laparoscopic, 258 robot-assisted, 151 hybrid) in 26 centers from 7 countries between 2007 and 2017. The primary outcome was POPF (International Study Group on Pancreatic Surgery grade B/C). Model performance was assessed using the area under the receiver operating curve (AUC; discrimination) and calibration plots. Validation included univariable screening for clinical variables that could improve performance. Results: Overall, 202 of 952 patients (21%) developed POPF after MIPD. Before adjustment, the original a-FRS performed moderately (AUC 0.68) and calibration was inadequate with systematic underestimation of the POPF risk. Single-row pancreatojejunostomy (odds ratio 4.6, 95 confidence interval [CI] 2.8-7.6) and male sex (odds ratio 1.9, 95 CI 1.4-2.7) were identified as important risk factors for POPF in MIPD. The updated a-FRS, consisting of body mass index, pancreatic texture, duct size, and male sex, showed good discrimination (AUC 0.75, 95 CI 0.71-0.79) and adequate calibration. Performance was adequate for laparoscopic, robot-assisted, and hybrid MIPD and open pancreatoduodenectomy. Conclusions: The updated a-FRS (www.pancreascalculator.com) now includes male sex as a risk factor and is validated for both MIPD and open pancreatoduodenectomy. The increased risk of POPF in laparoscopic MIPD was associated with single-row pancreatojejunostomy, which should therefore be discouraged.
AB - Objective: The aim of the study was to validate and optimize the alternative Fistula Risk Score (a-FRS) for patients undergoing minimally invasive pancreatoduodenectomy (MIPD) in a large pan-European cohort. Background: MIPD may be associated with an increased risk of postopera-tive pancreatic fistula (POPF). The a-FRS could allow for risk-adjusted comparisons in research and improve preventive strategies for high-risk patients. The a-FRS, however, has not yet been validated specifically for laparoscopic, robot-assisted, and hybrid MIPD. Methods: A validation study was performed in a pan-European cohort of 952 consecutive patients undergoing MIPD (543 laparoscopic, 258 robot-assisted, 151 hybrid) in 26 centers from 7 countries between 2007 and 2017. The primary outcome was POPF (International Study Group on Pancreatic Surgery grade B/C). Model performance was assessed using the area under the receiver operating curve (AUC; discrimination) and calibration plots. Validation included univariable screening for clinical variables that could improve performance. Results: Overall, 202 of 952 patients (21%) developed POPF after MIPD. Before adjustment, the original a-FRS performed moderately (AUC 0.68) and calibration was inadequate with systematic underestimation of the POPF risk. Single-row pancreatojejunostomy (odds ratio 4.6, 95 confidence interval [CI] 2.8-7.6) and male sex (odds ratio 1.9, 95 CI 1.4-2.7) were identified as important risk factors for POPF in MIPD. The updated a-FRS, consisting of body mass index, pancreatic texture, duct size, and male sex, showed good discrimination (AUC 0.75, 95 CI 0.71-0.79) and adequate calibration. Performance was adequate for laparoscopic, robot-assisted, and hybrid MIPD and open pancreatoduodenectomy. Conclusions: The updated a-FRS (www.pancreascalculator.com) now includes male sex as a risk factor and is validated for both MIPD and open pancreatoduodenectomy. The increased risk of POPF in laparoscopic MIPD was associated with single-row pancreatojejunostomy, which should therefore be discouraged.
UR - https://www.researchgate.net/publication/331531323_Updated_Alternative_Fistula_Risk_Score_ua-FRS_to_Include_Minimally_Invasive_Pancreatoduodenectomy_Pan-European_Validation
UR - http://www.mendeley.com/research/updated-alternative-fistula-risk-score-uafrs-include-minimally-invasive-pancreatoduodenectomy
UR - http://www.scopus.com/inward/record.url?scp=85099721347&partnerID=8YFLogxK
U2 - 10.1097/SLA.0000000000003234
DO - 10.1097/SLA.0000000000003234
M3 - Journal articles
SN - 0003-4975
VL - 273
SP - 334
EP - 340
JO - Annals of Surgery
JF - Annals of Surgery
IS - 2
ER -
Mungroop T, Klompmaker S, Wellner U, Steyerberg E, Coratti A, D'Hondt M et al. Updated Alternative Fistula Risk Score (ua-FRS) to Include Minimally Invasive Pancreatoduodenectomy: Pan-European Validation. Annals of Surgery. 2021 Feb 1;273(2):334-340. doi: 10.1097/SLA.0000000000003234
