ArticleSurgical endoscopy2026
A predictive model for postoperative hemorrhage in patients with clinically relevant pancreatic fistula following minimally invasive pancreaticoduodenectomy.
Article in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundPostpancreatectomy hemorrhage (PPH) remains the most lethal complication following pancreaticoduodenectomy. Patients who develop clinically relevant postoperative pancreatic fistula (CR-POPF) are at particularly high risk. A preoperative model tailored to CR-POPF patients is needed to enable early risk stratification and targeted perioperative strategies.
methodsWe conducted a retrospective multicenter case-control study across five high-volume pancreatic centers from 2010 to 2024. Consecutive patients who underwent minimally invasive pancreaticoduodenectomy (MIPD) and subsequently developed CR-POPF were included and split into a derivation (n = 304) and an external validation cohort (n = 187). Variables were screened using least absolute shrinkage and selection operator (LASSO) and entered multivariable logistic regression. Model performance was assessed by receiver operating characteristic analysis, calibration analysis, Brier score, Hosmer-Lemeshow test and decision-curve analysis. A nomogram and individualized risk formula were constructed to facilitate bedside application.
resultsLate PPH occurred in 25.6% (78/304) of the derivation cohort and 21.4% (40/187) of the validation cohort. Four independent indicators were identified: Tumor abutment of artery (odds ratio [OR] 10.32; 95% confidence interval [CI] 2.67-39.93; P < 0.01), receipt of preoperative neoadjuvant chemotherapy (OR 8.28; 95% CI 2.41-28.44; P < 0.01), Naples prognostic score > 2 (OR 17.88; 95% CI 6.74-47.42; P < 0.01), and Tumor size > 3 cm (OR 9.19; 95% CI 3.64-23.15; P < 0.01). Discrimination was excellent (AUC 0.952 derivation; 0.925 validation) with good calibration and low prediction error (Brier 0.067). A Youden-derived cutoff (0.192) separated risk groups with clear incidence gradients in validation (low vs high risk: 5.0% vs 68.8%).
conclusionThis four-variable, preoperative LASSO-logistic model offers a reliable tool for predicting late PPH among CR-POPF patients after MIPD. Early identification of high-risk individuals may enable targeted perioperative strategies and improved outcomes.
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