Alternative Fistula Risk Score for Pancreatoduodenectomy (a-FRS): Design and International External Validation

Timothy H. Mungroop, L. Bengt van Rijssen, David van Klaveren, F. Jasmijn Smits, Victor van Woerden, Ralph J. Linnemann, Matteo de Pastena, Sjors Klompmaker, Giovanni Marchegiani, Brett L. Ecker, Susan van Dieren, Bert Bonsing, Olivier R. Busch, Ronald M. van Dam, Joris Erdmann, Casper H. van Eijck, Michael F. Gerhards, Harry van Goor, Erwin van der Harst, Ignace H. de Hingh & 23 others Koert P. de Jong, Geert Kazemier, Misha Luyer, Awad Shamali, Salvatore Barbaro, Thomas Armstrong, Arjun Takhar, Zaed Hamady, Joost Klaase, Daan J. Lips, I. Quintus Molenaar, Vincent B. Nieuwenhuijs, Coen Rupert, Hjalmar C. van Santvoort, Joris J. Scheepers, George P. van der Schelling, Claudio Bassi, Charles M. Vollmer, Ewout W. Steyerberg, Mohammed Abu Hilal, Bas Groot Koerkamp, Marc G. Besselink, Dutch Pancreatic Cancer Group

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

OBJECTIVE: The aim of this study was to develop an alternative fistula risk score (a-FRS) for postoperative pancreatic fistula (POPF) after pancreatoduodenectomy, without blood loss as a predictor. BACKGROUND: Blood loss, one of the predictors of the original-FRS, was not a significant factor during 2 recent external validations. METHODS: The a-FRS was developed in 2 databases: the Dutch Pancreatic Cancer Audit (18 centers) and the University Hospital Southampton NHS. Primary outcome was grade B/C POPF according to the 2005 International Study Group on Pancreatic Surgery (ISGPS) definition. The score was externally validated in 2 independent databases (University Hospital of Verona and University Hospital of Pennsylvania), using both 2005 and 2016 ISGPS definitions. The a-FRS was also compared with the original-FRS. RESULTS: For model design, 1924 patients were included of whom 12% developed POPF. Three predictors were strongly associated with POPF: soft pancreatic texture [odds ratio (OR) 2.58, 95% confidence interval (95% CI) 1.80-3.69], small pancreatic duct diameter (per mm increase, OR: 0.68, 95% CI: 0.61-0.76), and high body mass index (BMI) (per kg/m increase, OR: 1.07, 95% CI: 1.04-1.11). Discrimination was adequate with an area under curve (AUC) of 0.75 (95% CI: 0.71-0.78) after internal validation, and 0.78 (0.74-0.82) after external validation. The predictive capacity of a-FRS was comparable with the original-FRS, both for the 2005 definition (AUC 0.78 vs 0.75, P = 0.03), and 2016 definition (AUC 0.72 vs 0.70, P = 0.05). CONCLUSION: The a-FRS predicts POPF after pancreatoduodenectomy based on 3 easily available variables (pancreatic texture, duct diameter, BMI) without blood loss and pathology, and was successfully validated for both the 2005 and 2016 POPF definition. The online calculator is available at www.pancreascalculator.com.
Original languageEnglish
Pages (from-to)937-943
JournalAnnals of Surgery
Volume269
Issue number5
Early online date12 Dec 2017
DOIs
Publication statusPublished - 1 May 2019

Cite this

Mungroop, T. H., van Rijssen, L. B., van Klaveren, D., Smits, F. J., van Woerden, V., Linnemann, R. J., ... Dutch Pancreatic Cancer Group (2019). Alternative Fistula Risk Score for Pancreatoduodenectomy (a-FRS): Design and International External Validation. Annals of Surgery, 269(5), 937-943. https://doi.org/10.1097/SLA.0000000000002620
Mungroop, Timothy H. ; van Rijssen, L. Bengt ; van Klaveren, David ; Smits, F. Jasmijn ; van Woerden, Victor ; Linnemann, Ralph J. ; de Pastena, Matteo ; Klompmaker, Sjors ; Marchegiani, Giovanni ; Ecker, Brett L. ; van Dieren, Susan ; Bonsing, Bert ; Busch, Olivier R. ; van Dam, Ronald M. ; Erdmann, Joris ; van Eijck, Casper H. ; Gerhards, Michael F. ; van Goor, Harry ; van der Harst, Erwin ; de Hingh, Ignace H. ; de Jong, Koert P. ; Kazemier, Geert ; Luyer, Misha ; Shamali, Awad ; Barbaro, Salvatore ; Armstrong, Thomas ; Takhar, Arjun ; Hamady, Zaed ; Klaase, Joost ; Lips, Daan J. ; Molenaar, I. Quintus ; Nieuwenhuijs, Vincent B. ; Rupert, Coen ; van Santvoort, Hjalmar C. ; Scheepers, Joris J. ; van der Schelling, George P. ; Bassi, Claudio ; Vollmer, Charles M. ; Steyerberg, Ewout W. ; Abu Hilal, Mohammed ; Groot Koerkamp, Bas ; Besselink, Marc G. ; Dutch Pancreatic Cancer Group. / Alternative Fistula Risk Score for Pancreatoduodenectomy (a-FRS) : Design and International External Validation. In: Annals of Surgery. 2019 ; Vol. 269, No. 5. pp. 937-943.
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title = "Alternative Fistula Risk Score for Pancreatoduodenectomy (a-FRS): Design and International External Validation",
abstract = "OBJECTIVE: The aim of this study was to develop an alternative fistula risk score (a-FRS) for postoperative pancreatic fistula (POPF) after pancreatoduodenectomy, without blood loss as a predictor. BACKGROUND: Blood loss, one of the predictors of the original-FRS, was not a significant factor during 2 recent external validations. METHODS: The a-FRS was developed in 2 databases: the Dutch Pancreatic Cancer Audit (18 centers) and the University Hospital Southampton NHS. Primary outcome was grade B/C POPF according to the 2005 International Study Group on Pancreatic Surgery (ISGPS) definition. The score was externally validated in 2 independent databases (University Hospital of Verona and University Hospital of Pennsylvania), using both 2005 and 2016 ISGPS definitions. The a-FRS was also compared with the original-FRS. RESULTS: For model design, 1924 patients were included of whom 12{\%} developed POPF. Three predictors were strongly associated with POPF: soft pancreatic texture [odds ratio (OR) 2.58, 95{\%} confidence interval (95{\%} CI) 1.80-3.69], small pancreatic duct diameter (per mm increase, OR: 0.68, 95{\%} CI: 0.61-0.76), and high body mass index (BMI) (per kg/m increase, OR: 1.07, 95{\%} CI: 1.04-1.11). Discrimination was adequate with an area under curve (AUC) of 0.75 (95{\%} CI: 0.71-0.78) after internal validation, and 0.78 (0.74-0.82) after external validation. The predictive capacity of a-FRS was comparable with the original-FRS, both for the 2005 definition (AUC 0.78 vs 0.75, P = 0.03), and 2016 definition (AUC 0.72 vs 0.70, P = 0.05). CONCLUSION: The a-FRS predicts POPF after pancreatoduodenectomy based on 3 easily available variables (pancreatic texture, duct diameter, BMI) without blood loss and pathology, and was successfully validated for both the 2005 and 2016 POPF definition. The online calculator is available at www.pancreascalculator.com.",
keywords = "Journal Article",
author = "Mungroop, {Timothy H.} and {van Rijssen}, {L. Bengt} and {van Klaveren}, David and Smits, {F. Jasmijn} and {van Woerden}, Victor and Linnemann, {Ralph J.} and {de Pastena}, Matteo and Sjors Klompmaker and Giovanni Marchegiani and Ecker, {Brett L.} and {van Dieren}, Susan and Bert Bonsing and Busch, {Olivier R.} and {van Dam}, {Ronald M.} and Joris Erdmann and {van Eijck}, {Casper H.} and Gerhards, {Michael F.} and {van Goor}, Harry and {van der Harst}, Erwin and {de Hingh}, {Ignace H.} and {de Jong}, {Koert P.} and Geert Kazemier and Misha Luyer and Awad Shamali and Salvatore Barbaro and Thomas Armstrong and Arjun Takhar and Zaed Hamady and Joost Klaase and Lips, {Daan J.} and Molenaar, {I. Quintus} and Nieuwenhuijs, {Vincent B.} and Coen Rupert and {van Santvoort}, {Hjalmar C.} and Scheepers, {Joris J.} and {van der Schelling}, {George P.} and Claudio Bassi and Vollmer, {Charles M.} and Steyerberg, {Ewout W.} and {Abu Hilal}, Mohammed and {Groot Koerkamp}, Bas and Besselink, {Marc G.} and {Dutch Pancreatic Cancer Group}",
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month = "5",
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doi = "10.1097/SLA.0000000000002620",
language = "English",
volume = "269",
pages = "937--943",
journal = "Annals of Surgery",
issn = "0003-4932",
publisher = "Lippincott Williams and Wilkins",
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Mungroop, TH, van Rijssen, LB, van Klaveren, D, Smits, FJ, van Woerden, V, Linnemann, RJ, de Pastena, M, Klompmaker, S, Marchegiani, G, Ecker, BL, van Dieren, S, Bonsing, B, Busch, OR, van Dam, RM, Erdmann, J, van Eijck, CH, Gerhards, MF, van Goor, H, van der Harst, E, de Hingh, IH, de Jong, KP, Kazemier, G, Luyer, M, Shamali, A, Barbaro, S, Armstrong, T, Takhar, A, Hamady, Z, Klaase, J, Lips, DJ, Molenaar, IQ, Nieuwenhuijs, VB, Rupert, C, van Santvoort, HC, Scheepers, JJ, van der Schelling, GP, Bassi, C, Vollmer, CM, Steyerberg, EW, Abu Hilal, M, Groot Koerkamp, B, Besselink, MG & Dutch Pancreatic Cancer Group 2019, 'Alternative Fistula Risk Score for Pancreatoduodenectomy (a-FRS): Design and International External Validation' Annals of Surgery, vol. 269, no. 5, pp. 937-943. https://doi.org/10.1097/SLA.0000000000002620

Alternative Fistula Risk Score for Pancreatoduodenectomy (a-FRS) : Design and International External Validation. / Mungroop, Timothy H.; van Rijssen, L. Bengt; van Klaveren, David; Smits, F. Jasmijn; van Woerden, Victor; Linnemann, Ralph J.; de Pastena, Matteo; Klompmaker, Sjors; Marchegiani, Giovanni; Ecker, Brett L.; van Dieren, Susan; Bonsing, Bert; Busch, Olivier R.; van Dam, Ronald M.; Erdmann, Joris; van Eijck, Casper H.; Gerhards, Michael F.; van Goor, Harry; van der Harst, Erwin; de Hingh, Ignace H.; de Jong, Koert P.; Kazemier, Geert; Luyer, Misha; Shamali, Awad; Barbaro, Salvatore; Armstrong, Thomas; Takhar, Arjun; Hamady, Zaed; Klaase, Joost; Lips, Daan J.; Molenaar, I. Quintus; Nieuwenhuijs, Vincent B.; Rupert, Coen; van Santvoort, Hjalmar C.; Scheepers, Joris J.; van der Schelling, George P.; Bassi, Claudio; Vollmer, Charles M.; Steyerberg, Ewout W.; Abu Hilal, Mohammed; Groot Koerkamp, Bas; Besselink, Marc G.; Dutch Pancreatic Cancer Group.

In: Annals of Surgery, Vol. 269, No. 5, 01.05.2019, p. 937-943.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Alternative Fistula Risk Score for Pancreatoduodenectomy (a-FRS)

T2 - Design and International External Validation

AU - Mungroop, Timothy H.

AU - van Rijssen, L. Bengt

AU - van Klaveren, David

AU - Smits, F. Jasmijn

AU - van Woerden, Victor

AU - Linnemann, Ralph J.

AU - de Pastena, Matteo

AU - Klompmaker, Sjors

AU - Marchegiani, Giovanni

AU - Ecker, Brett L.

AU - van Dieren, Susan

AU - Bonsing, Bert

AU - Busch, Olivier R.

AU - van Dam, Ronald M.

AU - Erdmann, Joris

AU - van Eijck, Casper H.

AU - Gerhards, Michael F.

AU - van Goor, Harry

AU - van der Harst, Erwin

AU - de Hingh, Ignace H.

AU - de Jong, Koert P.

AU - Kazemier, Geert

AU - Luyer, Misha

AU - Shamali, Awad

AU - Barbaro, Salvatore

AU - Armstrong, Thomas

AU - Takhar, Arjun

AU - Hamady, Zaed

AU - Klaase, Joost

AU - Lips, Daan J.

AU - Molenaar, I. Quintus

AU - Nieuwenhuijs, Vincent B.

AU - Rupert, Coen

AU - van Santvoort, Hjalmar C.

AU - Scheepers, Joris J.

AU - van der Schelling, George P.

AU - Bassi, Claudio

AU - Vollmer, Charles M.

AU - Steyerberg, Ewout W.

AU - Abu Hilal, Mohammed

AU - Groot Koerkamp, Bas

AU - Besselink, Marc G.

AU - Dutch Pancreatic Cancer Group

PY - 2019/5/1

Y1 - 2019/5/1

N2 - OBJECTIVE: The aim of this study was to develop an alternative fistula risk score (a-FRS) for postoperative pancreatic fistula (POPF) after pancreatoduodenectomy, without blood loss as a predictor. BACKGROUND: Blood loss, one of the predictors of the original-FRS, was not a significant factor during 2 recent external validations. METHODS: The a-FRS was developed in 2 databases: the Dutch Pancreatic Cancer Audit (18 centers) and the University Hospital Southampton NHS. Primary outcome was grade B/C POPF according to the 2005 International Study Group on Pancreatic Surgery (ISGPS) definition. The score was externally validated in 2 independent databases (University Hospital of Verona and University Hospital of Pennsylvania), using both 2005 and 2016 ISGPS definitions. The a-FRS was also compared with the original-FRS. RESULTS: For model design, 1924 patients were included of whom 12% developed POPF. Three predictors were strongly associated with POPF: soft pancreatic texture [odds ratio (OR) 2.58, 95% confidence interval (95% CI) 1.80-3.69], small pancreatic duct diameter (per mm increase, OR: 0.68, 95% CI: 0.61-0.76), and high body mass index (BMI) (per kg/m increase, OR: 1.07, 95% CI: 1.04-1.11). Discrimination was adequate with an area under curve (AUC) of 0.75 (95% CI: 0.71-0.78) after internal validation, and 0.78 (0.74-0.82) after external validation. The predictive capacity of a-FRS was comparable with the original-FRS, both for the 2005 definition (AUC 0.78 vs 0.75, P = 0.03), and 2016 definition (AUC 0.72 vs 0.70, P = 0.05). CONCLUSION: The a-FRS predicts POPF after pancreatoduodenectomy based on 3 easily available variables (pancreatic texture, duct diameter, BMI) without blood loss and pathology, and was successfully validated for both the 2005 and 2016 POPF definition. The online calculator is available at www.pancreascalculator.com.

AB - OBJECTIVE: The aim of this study was to develop an alternative fistula risk score (a-FRS) for postoperative pancreatic fistula (POPF) after pancreatoduodenectomy, without blood loss as a predictor. BACKGROUND: Blood loss, one of the predictors of the original-FRS, was not a significant factor during 2 recent external validations. METHODS: The a-FRS was developed in 2 databases: the Dutch Pancreatic Cancer Audit (18 centers) and the University Hospital Southampton NHS. Primary outcome was grade B/C POPF according to the 2005 International Study Group on Pancreatic Surgery (ISGPS) definition. The score was externally validated in 2 independent databases (University Hospital of Verona and University Hospital of Pennsylvania), using both 2005 and 2016 ISGPS definitions. The a-FRS was also compared with the original-FRS. RESULTS: For model design, 1924 patients were included of whom 12% developed POPF. Three predictors were strongly associated with POPF: soft pancreatic texture [odds ratio (OR) 2.58, 95% confidence interval (95% CI) 1.80-3.69], small pancreatic duct diameter (per mm increase, OR: 0.68, 95% CI: 0.61-0.76), and high body mass index (BMI) (per kg/m increase, OR: 1.07, 95% CI: 1.04-1.11). Discrimination was adequate with an area under curve (AUC) of 0.75 (95% CI: 0.71-0.78) after internal validation, and 0.78 (0.74-0.82) after external validation. The predictive capacity of a-FRS was comparable with the original-FRS, both for the 2005 definition (AUC 0.78 vs 0.75, P = 0.03), and 2016 definition (AUC 0.72 vs 0.70, P = 0.05). CONCLUSION: The a-FRS predicts POPF after pancreatoduodenectomy based on 3 easily available variables (pancreatic texture, duct diameter, BMI) without blood loss and pathology, and was successfully validated for both the 2005 and 2016 POPF definition. The online calculator is available at www.pancreascalculator.com.

KW - Journal Article

UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85064852937&origin=inward

UR - https://www.ncbi.nlm.nih.gov/pubmed/29240007

U2 - 10.1097/SLA.0000000000002620

DO - 10.1097/SLA.0000000000002620

M3 - Article

VL - 269

SP - 937

EP - 943

JO - Annals of Surgery

JF - Annals of Surgery

SN - 0003-4932

IS - 5

ER -

Mungroop TH, van Rijssen LB, van Klaveren D, Smits FJ, van Woerden V, Linnemann RJ et al. Alternative Fistula Risk Score for Pancreatoduodenectomy (a-FRS): Design and International External Validation. Annals of Surgery. 2019 May 1;269(5):937-943. https://doi.org/10.1097/SLA.0000000000002620