Doris Da Silva, Thibault Moyne, Charles De Ponthaud, Ugo Marchese, Maxime Barrat, Raphael Dautry, Maria Conticchio, G�raldine Rousseau, Charlotte Ronde-Roupie, Mathilde Wagner, Charles Roux, Philippe Soyer, Anthony Dohan, Olivier Scatton, David Fuks, Sebastien Gaujoux, Stylianos Tzedakis
J Gastrointest Surg. 2025 May 8:102078. doi: 10.1016/j.gassur.2025.102078. Online ahead of print.
Background: Identification of early predictors of postoperative pancreatic fistula (POPF) related postpancreatectomy hemorrhage (PPH) on contrast-enhanced computed tomography (CT) may help tailoring management after pancreaticoduodenectomy (PD) although no model has been validated so far.
Methods: A bicentric analysis of consecutive PD performed between 2017 and 2022 was performed. A recently reported CT-based score (CTS) was externally validated. Sensitivity refinements were proposed through a modified-CTS which was internally (development cohort, n=182) and externally validated (validation cohort, n=62). Bootstrap corrected Areas under the curve (AUCs), Sensitivity (Se) and Positive Predictive Value (PVV) were used to evaluate and compare the two scores.
Results: A total of 244 patients (55.1% women; median age: 68 years [IQR: 58.0-75.0], clinically relevant (cr)-POPF: 25.4%, cr-PPH: 13.9%) were included. CTS accurately predicted a cr-PPH with an AUC of 0.83 (1000-boostrap 95% CI: 0.76-0.89). The modified-CTS, made available online (https://stylianostzedakis.shinyapps.io/pph_risk_calculator/), included CTS with 2 supplementary variables selected from a multivariable backward-stepwise regression: Perianastomotic air bubbles, posterosuperior pancreaticojejunal (PJ) anastomosis collection, posterior PJ defect, PJ collection in contact with hepatic or gastroduodenal artery stump and arterial wall irregularities. When compared with the CTS, although modified-CTS AUC [95%CI] were similar in the validation cohort (0.81 [0.62-0.95] vs. 0.87 [0.56-0.96], DeLong p=0.7), Se and PPV for early PPH detection were significantly higher (0.82 [0.75-0.92] vs. 0.71 [0.35-0.75] and 0.95 [0.83-0.99] vs. 0.33 [0.12-0.62], McNemar's p = 0.03).
Conclusions: With a robust prediction model, early CT-scan after PD seems a valid tool for early identification of high-risk cr-PPH patients.