Evidence map›Paper›PMID 39390232›Full record

ArticleSurgical endoscopy2024

Proposal of a revised 3-tier "2 mm" risk classification model for postoperative pancreatic fistula in robotic pancreatoduodenectomy.

Pengfei Wu, Julia E Menso, Shuang Zhang, Thomas McPhaul, Fuqiang Zhao, Liling Huang, Kai Chen, Marc G Besselink, Jin He

Abstract readValidation Study
PubMed Publisher
In one paragraph

Article in Surgical endoscopy, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Pengfei WuDepartment of Surgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Blalock 685, Baltimore, MD, 21287, USA.
Julia E MensoDepartment of Surgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Blalock 685, Baltimore, MD, 21287, USA.
Shuang ZhangDepartment of Surgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Blalock 685, Baltimore, MD, 21287, USA.
Thomas McPhaulDepartment of Surgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Blalock 685, Baltimore, MD, 21287, USA.
Fuqiang ZhaoDepartment of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Liling HuangDepartment of Medical Oncology, Beijing Key Laboratory of Clinical Study On Anticancer Molecular Targeted Drugs, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Kai ChenDepartment of Surgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Blalock 685, Baltimore, MD, 21287, USA.
Marc G BesselinkDepartment of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, Netherlands.
Jin HeDepartment of Surgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Blalock 685, Baltimore, MD, 21287, USA. jhe11@jhmi.edu.ORCID 0000-0001-9149-2247

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe recent International Study Group for Pancreatic Surgery (ISGPS) risk classification for postoperative pancreatic fistula (grade B/C) was developed based on data from open and mixed minimally invasive pancreatoduodenectomy. The ISGPS risk classification model has not been validated specifically for POPF after robotic pancreatoduodenectomy (RPD).

methodsWe calculated the rate of POPF (ISGPS 2016 definition, grade B/C) by analyzing consecutive patients after RPD by surgeons after their learning curves (80 RPDs per surgeon). The validation of the ISGPS 4-tier and the simplified 3-tier risk classification was conducted using the area under the receiver operating curve (AUC).

resultsFrom 2019 to 2023, 187 patients after RPD were included. Neither the ISGPS 4-tier nor the simplified 3-tier classification model showed robust discrimination (AUC: 0.696 and 0.685, respectively). Moreover, both risk classifications failed to differentiate the rates of POPF and major complications among subgroups. Multivariate analysis suggested that soft pancreatic texture and pancreatic duct ≤ 2 mm were independent risk factors for POPF after RPD. After adjusting the duct size's cutoff from 3 to 2 mm, the revised 4-tier "2 mm" classification model showed no significant difference between risk categories B and C (6.7% vs. 9.4%, P = 0.063). The revised 3-tier "2 mm" classification model stratified patients into A (n = 54), B (n = 68), and C (n = 65) groups, with corresponding POPF rates of 0.0%, 8.8%, and 23.1% (P < 0.001), and major complication rates of 5.6, 14.7, and 24.6% (P = 0.014), respectively. Compared to the simplified 3-tier classification model, the revised 3-tier "2 mm" classification model showed improved discrimination (AUC: 0.753 vs. 0.685, P = 0.034) and clinical utility.

conclusionsThe current ISGPS 4-tier and the simplified 3-tier classification models lacked sufficient discrimination in patients after RPD. We propose a revised 3-tier "2 mm" risk classification model for RPD with a robust discrimination, which requires further international validation with prospectively obtained data.

Indexed as

Pancreatic FistulaPancreaticoduodenectomyPostoperative ComplicationsRobotic Surgical ProceduresAgedClassificationFemaleHumansMaleRisk FactorsROC CurvePancreatic fistulaPancreatoduodenectomyRisk factorsRobotic pancreatectomy

Identifiers

PMID39390232

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.