Risk stratification of clinically relevant delayed gastric emptying after pancreaticoduodenectomy

BMC Surgery

Research

Yuan-Yang Wang¹  Jun-Chao Guo¹  Xiao-Ying Yang¹  Ze-Ru Li¹  Wei-Bin Wang¹  Tian-Yu Li¹  Xian-Lin Han¹  Meng-Hua Dai¹  Bang-Bo Zhao¹  Cheng Qin¹ 

[1] Department of General Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China;

关键词: Pancreaticoduodenectomy;    Delayed gastric emptying;    Risk factor;    Risk model;    Logistic regression;   

DOI  :  10.1186/s12893-023-02110-7

 received in 2022-10-26, accepted in 2023-07-18,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundDelayed gastric emptying (DGE) remains one of the major complications after pancreaticoduodenectomy (PD), with discrepant reports of its contributing factors. This study aimed to develop a nomogram to identify potential predictors and predict the probability of DGE after PD.MethodsThis retrospective study enrolled 422 consecutive patients who underwent PD from January 2019 to December 2021 at our institution. The LASSO algorithm and multivariate logistic regression were performed to identify independent risk and protective factors associated with clinically relevant delayed gastric emptying (CR-DGE). A nomogram was established based on the selected variables. Then, the calibration curve, ROC curve, decision curve analysis (DCA), and clinical impact curve (CIC) were applied to evaluate the predictive performance of our model. Finally, an independent cohort of 45 consecutive patients from January 2022 to March 2022 was enrolled to further validate the nomogram.ResultsAmong 422 patients, CR-DGE occurred in 94 patients (22.2%). A previous history of chronic gastropathy, intraoperative plasma transfusion ≥ 400 ml, end-to-side gastrointestinal anastomosis, intra-abdominal infection, incisional infection, and clinically relevant postoperative pancreatic fistula (CR-POPF) were identified as risk predictors. Minimally invasive pancreaticoduodenectomy (MIPD) was demonstrated to be a protective predictor of CR-DGE. The areas under the curve (AUCs) were 0.768 (95% CI, 0.706–0.830) in the development cohort, 0.766 (95% CI, 0.671–0.861) in the validation cohort, and 0.787 (95% CI, 0.633–0.940) in the independent cohort. Then, we built a simplified scale based on our nomogram for risk stratification.ConclusionsOur study identified seven predictors and constructed a validated nomogram that effectively predicted CR-DGE for patients who underwent PD.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

【 图 表 】

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