Publicaciones científicas
Tailoring the Use of Central Pancreatectomy Through Prediction Models for Major Morbidity and Postoperative Diabetes: International Retrospective Multicenter Study
Eduard Antonie van Bodegraven 1 2 , Sanne Lof 1 2 , Leia Jones 3 , Béatrice Aussilhou 4 , Gao Yong 5 , Wei Jishu 5 , Rosa Klotz 6 , Dario Missael Rocha-Castellanos 7 , Ippei Matsumato 8 , Charles de Ponthaud 9 , Kimitaka Tanaka 10 , Esther Biesel 11 , Emmanuele Kauffmann 12 , Traian Dumitrascu 13 , Yuichi Nagakawa 14 , Pablo Martí-Cruchaga 15 , Geert Roeyen 16 , Alessandro Zerbi 17 , Mara Goetz 18 , Vincent de Meijer 19 , Patrick Pessaux 20 , Povilas Ignatavicius 21 , Ihsan Demir 22 , Mario Giuffrida 23 , Bobby Tingstedt 24 , Marco Vito Marino 25 , Sotiris Mastoridis 26 , Maximilian Brunner 27 , Isabel Mora-Oliver 28 , Cecilia Bortolato 29 , Aisté Gulla 30 , Thomas Apers 31 , Hélène Hermand 4 , Yusuke Mitsuka 14 , Irinel Popescu 13 , Ugo Boggi 12 , Uwe Wittel 11 , Satoshi Hirano 10 , Sébastien Gaujoux 9 , Keiko Kamei 8 , Carlos Fernández-Del Castillo 7 , Thilo Hackert 6 32 , Jiang Kuirong 5 , Miao Yi 5 , Alain Sauvanet 4 , Marc Besselink 1 2 , Mohammad Abu Hilal 3 , Safi Dokmak 4 ; European Consortium on Minimally Invasive Pancreatic Surgery and the International Consortium on Minimally Invasive Pancreatic Surgery
Objective: To develop a prediction model for major morbidity and endocrine dysfunction after CP which could help in tailoring the use of this procedure.
Summary background data: Central pancreatectomy (CP) is a parenchyma-sparing alternative to distal pancreatectomy for symptomatic benign and pre-malignant tumors in body and neck of the pancreas CP lowers the risk of new-onset diabetes and exocrine pancreatic insufficiency compared to distal pancreatectomy but it is thought to increase the risk of short-term complications including postoperative pancreatic fistula (POPF).
Methods: International multicenter retrospective cohort study including patients from 51 centers in 19 countries (2010-2021). Primary endpoint was major morbidity. Secondary endpoints included POPF grade B/C, endocrine dysfunction, and the use of pancreatic enzymes. Two risk model were designed for major morbidity and endocrine dysfunction utilizing multivariable logistic regression and internal and external validation.
Results: 838 patients after CP were included (301 (36%) minimally invasive) and major morbidity occurred in 248 (30%) patients, POPF B/C in 365 (44%), and 30-day mortality in 4 (1%). Endocrine dysfunction in 91 patients (11%) and use of pancreatic enzymes in 108 (12%). The risk model for major morbidity included male sex, age, BMI, and ASA score≥3. The model performed acceptable with an area under curve (AUC) of 0.72(CI:0.68-0.76). The risk model for endocrine dysfunction included higher BMI and male sex and performed well (AUC:0.83 (CI:0.77-0.89)).
Conclusions: The proposed risk models help in tailoring the use of CP in patients with symptomatic benign and premalignant lesions in the body and neck of the pancreas and are readily available via www.pancreascalculator.com.
CITA DEL ARTICULO Ann Surg. 2023 Dec 11. doi: 10.1097/SLA.0000000000006157
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