Publicaciones científicas

Tailoring the Use of Central Pancreatectomy Through Prediction Models for Major Morbidity and Postoperative Diabetes: International Retrospective Multicenter Study

11-dic-2023 | Revista: Annals of Surgery

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